Pathogens Associated With Sepsis in Newborns and Young Infants in Developing Countries
Pathogens Associated With Sepsis in Newborns and Young Infants in Developing Countries
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DOI：
10.1097/inf.0b013e3181958769
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发表时间：
2009-01-01
影响因子：
3.6
通讯作者：
Khan, Tauseef Ahmed
中科院分区：
文献类型：
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作者：
Zaidi, Anita K. M.;Thaver, Durrane;Khan, Tauseef Ahmed
简介：了解引起幼儿（90 天以下）感染的病原体对于制定基于社区的管理策略至关重要。来自发展中国家的大多数病原学数据都是以医院为基础的，可能与大多数婴儿在家中出生的社区关系不大。方法：我们检索了来自发展中国家的研究文献，这些研究报告了自 1980 年以来发表的社区获得性感染（脓毒症、肺炎、脑膜炎）的病因学。纳入了报告早发性脓毒症、入院或在家出生的婴儿脓毒症的医院研究。结果：共 63 项 研究中，13 项重点关注社区获得性感染，但来自家庭出生的新生儿的数据有限。在出生后第一周（3209 株分离株），克雷伯菌属（25%）、大肠杆菌（15%）和金黄色葡萄球菌（18%）是主要病原体。尽管存在地区差异，B 族链球菌 (GBS) 相对不常见 (7%)。出生第一周后（835 株分离株）。金黄色葡萄球菌（14%）：GBS（12%）、肺炎链球菌（12%）。最常见的是非伤寒沙门氏菌 (13%)。肺炎链球菌 (27%) 在新生儿后期最常见（141 种分离株中）。在家分娩的婴儿（170 种分离株中）中革兰氏阴性菌占主导地位（77%）。结论：关于社区环境中严重细菌感染的病因学信息有限。医院研究表明，出生后第一周的大多数感染是由革兰氏阴性病原体引起的，并且由于不卫生的分娩方式，许多感染可能是环境感染而不是母体感染。这种做法也可以解释在家中出生的婴儿中革兰氏阴性菌感染的普遍性，尽管来自家庭环境的数据有限。这些发现对于制定社区和医院的预防和管理策略具有重要意义。
Introduction: Knowledge of pathogens causing infections in young infants (up to 90 days of life) is essential for devising community-based management strategies. Most etiological data from developing countries are hospital-based and may have little relevance to communities in which most babies are born at home.Methods: We searched the literature for studies from developing countries reporting etiology of community-acquired infections (sepsis, pneumonia, meningitis) published since 1980. Hospital-based studies reporting early onset sepsis, sepsis among babies admitted from, or born at home were included.Results: Of 63 studies, 13 focused on community-acquired infections, but limited data were available from home-born neonates. In the first week of life (3209 isolates), Klebsiella species (25%), Escherichia coli (15%), and Staphylococcus aureus (18%) were major pathogens. Group B streptococci (GBS) were relatively uncommon (7%), although regional differences existed. After the first week of life (835 isolates),. aureus (14%): GBS (12%), Streptococcus pnemoniae (12%). and nontyphoidal Salmonella species (13%) were most frequent. S. pneumoniae (27%) was most common in the postneonatal period (among 141 isolates). Gram-negatives predominated (77%) among home-delivered babies (among 170 isolates).Conclusions: Limited information is available on etiology of serious bacterial infections in community settings. Hospital-based studies suggest that most infections in the first week of life are due to Gram-negative pathogens, and many may be environmentally rather than maternally-acquired, owing to unhygienic delivery practices. Such practices may also explain the predominance of Gram-negative infections among home-born infants, although data from home settings are limited. These findings have implications for developing prevention and management strategies in communities and hospitals.