Extended-spectrum β lactamase-producing gram-negative bacteria:: clinical profile and outcome in a neonatal intensive care unit
Extended-spectrum β lactamase-producing gram-negative bacteria:: clinical profile and outcome in a neonatal intensive care unit
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DOI：
10.1179/146532807x170501
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发表时间：
2007-03-01
影响因子：
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通讯作者：
Agarwal, Pushpa
中科院分区：
文献类型：
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作者：
Sehgal, Rachna;Gaind, Rajni;Agarwal, Pushpa
背景与目的：多药耐药广谱β -内酰胺酶产生菌（ESBL）已成为全球普遍存在的问题。然而，关于新生儿感染产生esbl的革兰氏阴性菌的临床概况和结果的数据很少。方法：对2002年4月至2003年5月在新德里Safdarjang医院新生儿重症监护病房收治的所有革兰氏阴性菌血培养阳性的新生儿进行回顾性研究。每位患者的临床资料和结果均来自病例记录。比较ESBL组和非ESBL组的死亡率和发病率。数据分析采用chi(2)和Student’st检验。结果：革兰氏阴性败血症75例，新生儿感染产esb菌46例（61.3%），有记录63例。ESBL的产生与早产（24/38 vs 9/25,p = 0.03）、胎膜破裂时间延长（14/38 vs 2/25,p = 0.01）和以前给过婴儿抗生素（15/38 vs 1/25, p = 0.002）有关。50%的早发性败血症婴儿和82.1%的晚发性败血症婴儿感染了ESBL菌株。ESBL脓毒症的新生儿更有可能出现持续的热不稳定（13/38 vs 3/25, p = 0.04）和喂养前胃吸痰（18/38 vs 3/25, p = 0.004）。90%以上的ESBL分离株对碳青霉烯类、头孢哌酮舒巴坦和哌拉西林他唑巴坦敏感。ESBL组的平均保育时间（15.8天vs 10.7天，p = 0.02）和死亡率（23.6天vs 4.0%,p = 0.07）高于ESBL组，并且该组的饲料开始时间延迟（7.6天vs 3.9天，p =0.007）。结论：早发性败血症病例中ESBL的分离表明ESBL生产者可能已经渗透到社区中。在新生儿败血症病例中，早期怀疑产生esbl的分离株可以促进及时采取适当的经验性治疗，并改善结果。
Background & aims: Multidrug-resistant extended-spectrum beta lactamase-producing bacteria (ESBL) have emerged as a common problem globally. However, data regarding clinical profile and outcome in neonates infected with ESBL-producing gram-negative bacteria are sparse.Methods: A retrospective study was undertaken of all neonates admitted between April 2002 and May 2003 to the neonatal intensive care unit, Safdarjang Hospital, New Delhi who had blood cultures positive for gram-negative bacteria. The clinical profile and outcome in each patient was obtained from the case notes. The mortality and morbidity of the ESBL (cases) and non-ESBL groups were compared. Data were analysed using the chi(2) and Student's t-tests.Results: There were 75 cases of gram-negative septicaemia, 46 newborns (61.3%) were infected with ESBL-producing strains and 63 case records were available. ESBL production was associated with prematurity (24/38 vs 9/25,p = 0.03), prolonged rupture of membranes (14/38 vs 2/25,p = 0.01) and previous antibiotic administration to the infant (15/38 vs 1/25, p = 0.002). Fifty per cent of infants with early-onset sepsis and 82.1% with late-onset sepsis were infected with ESBL strains. Newborns with ESBL sepsis were more likely to manifest persistent thermal instability (13/38 vs 3/25, p = 0.04) and pre-feed gastric aspirates (18/38 vs 3/25, p = 0.004). More than 90% of ESBL isolates were susceptible to carbapenems, cefperazone-sulbactam and piperacillin-tazobactam. The mean length of nursery stay (15.8 vs 10.7,p = 0.02) and mortality (23.6 vs 4.0%,p = 0.07) were higher in the ESBL group and onset of feeds was delayed (7.6 vs 3.9 days, p=0.007) in this group.Conclusions: Isolation of ESBL in cases of early-onset sepsis indicates that ESBL producers might have percolated into the community. Early suspicion of ESBL-producing isolates in cases of neonatal sepsis can facilitate prompt institution of appropriate empirical therapy and lead to an improved outcome.