Neonatal Escherichia coli Bloodstream Infections: Clinical Outcomes and Impact of Initial Antibiotic Therapy.
Neonatal Escherichia coli Bloodstream Infections: Clinical Outcomes and Impact of Initial Antibiotic Therapy.
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DOI：
10.1097/inf.0000000000000769
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发表时间：
2015-09
期刊：
影响因子：
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通讯作者：
Antibacterial Resistance Leadership Group
中科院分区：
文献类型：
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作者：
Bergin SP;Thaden JT;Ericson JE;Cross H;Messina J;Clark RH;Fowler VG Jr;Benjamin DK Jr;Hornik CP;Smith PB;Antibacterial Resistance Leadership Group
大肠埃希氏菌是婴儿血液感染(BSI)的常见原因，与幸存者的高死亡率和发病率有关。在这一人群中，抗生素耐药性的临床意义和适当的抗微生物治疗的时机还知之甚少。2012年，我们确认了所有从儿科医疗集团管理的77个新生儿重症监护病房出院的患有大肠杆菌BSI的婴儿。我们使用多变量Logistic回归来评估30天死亡率与氨苄西林耐药大肠埃希菌BSI之间的关系，以及在第一次血培养阳性当天应用有效经验性抗菌药物的数量、控制胎龄、小于胎龄状态、早发与晚发BSI、氧气需求、呼吸机支持和肌力支持之间的关系。我们鉴定了258例大肠埃希菌BSI，其中123例(48%)对氨苄西林耐药。未调整的30天死亡率在氨苄西林耐药和敏感的大肠杆菌BSI婴儿之间没有显著差异(11/123[9%]比7/135[5%]；p=0.33；调整后的优势比=1.37[95%可信区间0.39，4.77])。在氨苄西林耐药大肠杆菌BSI中，接受至少一种抗菌素经验剂治疗的婴儿与未接受任何经验剂治疗的婴儿相比，30天的死亡率没有显著降低(调整后的优势比=1.50[0.07，33.6])。在这群患有大肠杆菌BSI的婴儿中，氨苄西林耐药与死亡率的显著增加无关。在氨苄西林耐药大肠杆菌婴儿亚组中，适当的经验性抗生素治疗与较低的死亡率无关。
Escherichia coli is a common cause of bloodstream infections (BSI) in infants and is associated with high mortality and morbidity among survivors. The clinical significance of antibiotic resistance and timing of appropriate antimicrobial therapy in this population is poorly understood. We identified all infants with E. coli BSIs discharged from 77 neonatal intensive care units managed by the Pediatrix Medical Group in 2012. We used multivariable logistic regression to evaluate the association between 30-day mortality and ampicillin-resistant E. coli BSI, as well as the number of active empiric antimicrobial agents administered, controlling for gestational age, small-for-gestational age status, early- versus late-onset BSI, oxygen requirement, ventilator support, and inotropic support on the day of the first positive blood culture. We identified 258 episodes of E. coli BSI, including 123 (48%) ampicillin-resistant isolates. Unadjusted 30-day mortality did not significantly differ between infants with ampicillin-resistant vs. -susceptible E. coli BSI (11/123 [9%] vs. 7/135 [5%]; p=0.33; adjusted odds ratio=1.37 [95% confidence interval 0.39, 4.77]). Among ampicillin-resistant E. coli BSIs, 30-day mortality was not significantly lower for infants treated with at least one empiric antimicrobial active against ampicillin-resistant E. coli vs. infants receiving no active empiric agent (adjusted odds ratio=1.50 [0.07, 33.6]). In this population of infants with E. coli BSI, ampicillin resistance was not associated with significantly increased mortality. Among the subset of infants with ampicillin-resistant E. coli, appropriate empirical antibiotic therapy was not associated with lower mortality.