Antimicrobial Susceptibility Profiles Among Neonatal Early-onset Sepsis Pathogens.
Antimicrobial Susceptibility Profiles Among Neonatal Early-onset Sepsis Pathogens.
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新生儿早发病原体之间的抗菌敏感性谱。
DOI：
10.1097/inf.0000000000003380
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发表时间：
2022-03-01
期刊：
影响因子：
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通讯作者：
for the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network
中科院分区：
文献类型：
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作者：
Flannery DD;Puopolo KM;Hansen NI;Gerber JS;Sánchez PJ;Stoll BJ;for the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network
对于有早发性脓毒症（EOS）风险的新生儿，建议经验性给予氨苄西林和庆大霉素。所有EOS病原体的抗菌药物敏感性数据有限。回顾性审查了2015年4月至2017年3月在新生儿研究网络中心接受护理的妊娠≥22周婴儿的前瞻性EOS监测研究的抗菌药物敏感性数据。非敏感性定义为最终结果的中间或耐药。我们在217，480例活产婴儿中的235例EOS病例中确定了239种病原体（235种细菌，4种真菌）。189/239（79.1%）株分离株的抗菌药物敏感性数据可用。在81株具有氨苄青霉素和/或庆大霉素敏感性数据的革兰氏阳性分离株中，所有分离株在体外均对氨苄青霉素或庆大霉素敏感。在具有氨苄青霉素和/或庆大霉素敏感性数据的革兰氏阴性分离株中，72/94（76.6%）分离株对氨苄青霉素不敏感，8/94（8.5%）分离株对庆大霉素不敏感，7/96（7.3%）分离株对两者均不敏感。5%或更少的革兰氏阴性分离株对第3代或第4代头孢菌素、哌拉西林-他唑巴坦和碳青霉烯类抗生素不敏感。总体而言，我们估计8%的EOS病例是由对氨苄青霉素和庆大霉素均不敏感的分离株引起的;这些病例最有可能发生在早产、极低出生体重儿中。绝大多数当代EOS病原体对氨苄青霉素和庆大霉素的组合敏感。临床医生可能会考虑在EOS风险最高的新生儿中增加广谱治疗，但我们警告说，无论是替代还是添加一种单一的抗菌药物都不可能在所有情况下提供足够的经验性治疗。
Empiric administration of ampicillin and gentamicin is recommended for newborns at risk of early-onset sepsis (EOS). There are limited data on antimicrobial susceptibility of all EOS pathogens. Retrospective review of antimicrobial susceptibility data from a prospective EOS surveillance study of infants born ≥22 weeks’ gestation and cared for in Neonatal Research Network centers 4/2015–3/2017. Non-susceptible was defined as intermediate or resistant on final result. We identified 239 pathogens (235 bacteria, 4 fungi) in 235 EOS cases among 217,480 live-born infants. Antimicrobial susceptibility data were available for 189/239 (79.1%) isolates. Among 81 gram-positive isolates with ampicillin and/or gentamicin susceptibility data, all were susceptible in vitro to either ampicillin or gentamicin. Among gram-negative isolates with ampicillin and/or gentamicin susceptibility data, 72/94 (76.6%) isolates were non-susceptible to ampicillin, 8/94 (8.5%) were non-susceptible to gentamicin, and 7/96 (7.3%) isolates were non-susceptible to both. Five percent or less of tested gram-negative isolates were non-susceptible to each of 3rd or 4th generation cephalosporins, piperacillin-tazobactam and carbapenems. Overall, we estimated that 8% of EOS cases were caused by isolates non-susceptible to both ampicillin and gentamicin; these were most likely to occur among preterm, very-low birth weight infants. The vast majority of contemporary EOS pathogens are susceptible to the combination of ampicillin and gentamicin. Clinicians may consider the addition of broader-spectrum therapy among newborns at highest risk of EOS, but we caution that neither the substitution nor the addition of one single antimicrobial agent is likely to provide adequate empiric therapy in all cases.