Neonatal sepsis: Progress towards improved outcomes
Neonatal sepsis: Progress towards improved outcomes
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DOI：
10.1016/j.jinf.2013.09.011
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发表时间：
2014-01-01
影响因子：
28.2
通讯作者：
Stoll, Barbara J.
中科院分区：
文献类型：
--
作者：
Shane, Andi L.;Stoll, Barbara J.
由于多次暴露和相对受损的免疫系统，新生儿易在围产期感染。新生儿感染造成的疾病负担因地理区域以及孕产妇和新生儿风险因素而异。据估计，全世界每年有140多万新生儿死于侵入性感染。早发性新生儿脓毒症（EOS）的危险因素包括早产、免疫不成熟、母体B群链球菌定植、胎膜长期破裂和母体羊膜内感染。产时给予吉兰-巴雷综合征患者的预防性抗菌药物减少了与早发性吉兰-巴雷综合征侵袭性感染相关的疾病负担。主动监测已确定革兰氏阴性病原体作为早期侵袭性感染的新病因。由革兰氏阳性菌（包括凝固酶阴性葡萄球菌和金黄色葡萄球菌）引起的迟发性新生儿脓毒症（LOS）与早产儿发病率和死亡率增加有关。侵袭性念珠菌病是迟发性败血症的新原因，特别是在接受广谱抗菌药物的婴儿中。在生命的前6周对极低出生体重（VLBW）新生儿预防性给予氟康唑可减少真菌感染率高的新生儿重症监护病房的侵袭性念珠菌病。通过抗菌药物管理、有限使用类固醇、早期肠内喂养、有限使用侵入性装置和标准化导管护理实践以及细致的手部卫生来预防卫生保健相关感染是减轻迟发性新生儿败血症负担的重要且具有成本效益的策略。(C) 2013年英国感染协会。Elsevier Ltd.出版。版权所有。
Neonates are predisposed to infections during the perinatal period due to multiple exposures and a relatively compromised immune system. The burden of disease attributed to neonatal infections varies by geographic region and maternal and neonatal risk factors. Worldwide, it is estimated that more than 1.4 million neonatal deaths annually are the consequence of invasive infections. Risk factors for early-onset neonatal sepsis (EOS) include prematurity, immunologic immaturity, maternal Group B streptococcal colonization, prolonged rupture of membranes, and maternal intra-amniotic infection. Intrapartum antimicrobial prophylaxis administered to GBS-colonized women has reduced the burden of disease associated with early onset GBS invasive infections. Active surveillance has identified Gram-negative pathogens as an emerging etiology of early-onset invasive infections. Late-onset neonatal sepsis (LOS) attributable to Gram-positive organisms, including coagulase negative Staphylococci and Staphylococcus aureus, is associated with increased morbidity and mortality among premature infants. Invasive candidiasis is an emerging cause of late-onset sepsis, especially among infants who receive broad spectrum antimicrobial agents. Prophylactic fluconazole administration to very low birthweight (VLBW) neonates during the first 6 weeks of life reduces invasive candidiasis in neonatal intensive care units with high rates of fungal infection. Prevention of healthcare associated infections through antimicrobial stewardship, limited steroid use, early enteral feeding, limited use of invasive devices and standardization of catheter care practices, and meticulous hand hygiene are important and cost-effective strategies for reducing the burden of late-onset neonatal sepsis. (C) 2013 The British Infection Association. Published by Elsevier Ltd. All rights reserved.