Early-Onset Neonatal Sepsis in Low- and Middle-Income Countries: Current Challenges and Future Opportunities.
Early-Onset Neonatal Sepsis in Low- and Middle-Income Countries: Current Challenges and Future Opportunities.
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低收入和中等收入国家的早期发作的新生儿败血症：当前的挑战和未来的机会。
DOI：
10.2147/idr.s294156
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发表时间：
2022
影响因子：
3.9
通讯作者：
Walsh TR
中科院分区：
文献类型：
--
作者：
Sands K;Spiller OB;Thomson K;Portal EAR;Iregbu KC;Walsh TR
新生儿脓毒症被定义为出生后 28 天内的全身感染，早发性脓毒症 (EOS) 发生在出生后 72 小时内，尽管 EOS 的定义在文献中有所不同。尽管全球发病率在过去十年中急剧下降，但新生儿败血症仍然是新生儿死亡率的一个重要原因，在低收入和中等收入国家 (LMIC) 中死亡率最高。新生儿败血症发作时的症状可能很微妙，因此 EOS 通常很难从临床表现和实验室检测中诊断出来，而且血培养并不总是结论性的或可获得的，特别是在资源有限的国家。尽管世界卫生组织 (WHO) 目前提倡使用 β-内酰胺和庆大霉素作为一线治疗，但可用性和成本会影响经验性抗生素治疗。中低收入国家新生儿败血症的抗生素治疗差异很大，部分原因是抗生素成本（以及由谁支付）和某些抗生素的获取等因素。在过去十年中，抗菌素耐药性 (AMR) 显着增加，本综述讨论了 EOS 诊断和治疗中现有的微生物学数据。重要的是，本次综述强调了脓毒症病原体的数据可用性、方法、诊断可用性和病因学方面的巨大差异。
Neonatal sepsis is defined as a systemic infection within the first 28 days of life, with early-onset sepsis (EOS) occurring within the first 72h, although the definition of EOS varies in literature. Whilst the global incidence has dramatically reduced over the last decade, neonatal sepsis remains an important cause of neonatal mortality, highest in low- and middle-income countries (LMICs). Symptoms at the onset of neonatal sepsis can be subtle, and therefore EOS is often difficult to diagnose from clinical presentation and laboratory testing and blood cultures are not always conclusive or accessible, especially in resource limited countries. Although the World Health Organisation (WHO) currently advocates a ß-lactam, and gentamicin for first line treatment, availability and cost influence the empirical antibiotic therapy administered. Antibiotic treatment of neonatal sepsis in LMICs is highly variable, partially caused by factors such as cost of antibiotics (and who pays for them) and access to certain antibiotics. Antimicrobial resistance (AMR) has increased considerably over the past decade and this review discusses current microbiology data available in the context of the diagnosis, and treatment for EOS. Importantly, this review highlights a large variability in data availability, methodology, availability of diagnostics, and aetiology of sepsis pathogens.