Neonatal multidrug-resistant gram-negative infection: epidemiology, mechanisms of resistance, and management.
Neonatal multidrug-resistant gram-negative infection: epidemiology, mechanisms of resistance, and management.
复制标题
DOI：
10.1038/s41390-021-01745-7
复制
发表时间：
2022-01
影响因子：
3.6
通讯作者：
Puopolo KM
中科院分区：
文献类型：
--
作者：
Flannery DD;Chiotos K;Gerber JS;Puopolo KM
由于免疫系统不成熟、住院时间长和频繁使用侵入性设备，入住新生儿重症监护室的婴儿，特别是早产儿，感染的风险很高。新的证据表明，新生儿环境中的多重耐药革兰氏阴性菌 (MDR-GN) 感染正在增加，这直接威胁到当代新生儿护理的近期和持续进展。常见新生儿病原体中抗生素耐药性不断上升，给疑似和确诊新生儿感染的最佳管理带来了挑战。我们回顾了美国和国际上新生儿 MDR-GN 感染的流行病学，重点关注产超广谱 β-内酰胺酶 (ESBL) 肠杆菌和碳青霉烯类耐药肠杆菌 (CRE)。我们包括已发表的单中心研究、新生儿合作报告和国家监测数据。讨论了耐药的危险因素和机制。此外，我们还讨论了针对疑似感染的经验性抗生素治疗的当前建议，以及针对关键多重耐药微生物的明确治疗方案。最后，我们回顾了预防的最佳实践，并确定了当前的知识差距和未来研究的领域。
Infants admitted to the neonatal intensive care unit, particularly those born preterm, are at high risk for infection due to the combination of an immature immune system, prolonged hospitalization, and frequent use of invasive devices. Emerging evidence suggests that multidrug resistant gram-negative (MDR-GN) infections are increasing in neonatal settings, which directly threatens recent and ongoing advances in contemporary neonatal care. A rising prevalence of antibiotic resistance among common neonatal pathogens compounds the challenge of optimal management of suspected and confirmed neonatal infection. We review the epidemiology of MDR-GN infections in neonates in the United States and internationally, with a focus on extended-spectrum β-lactamase (ESBL)-producing Enterobacterales and carbapenem-resistant Enterobacterales (CRE). We include published single center studies, neonatal collaborative reports, and national surveillance data. Risk factors for and mechanisms of resistance are discussed. Additionally, we discuss current recommendations for empiric antibiotic therapy for suspected infections, as well as definitive treatment options for key multidrug resistant organisms. Finally, we review best practices for prevention and identify current knowledge gaps and areas for future research.
登录
查看更多内容
影响因子：
1.1
作者：
Arnold RS;Thom KA;Sharma S;Phillips M;Kristie Johnson J;Morgan DJ
通讯作者：
Morgan DJ
影响因子：
3.6
作者：
Bradley, John S.;Roilides, Emmanuel;Gardner, Annie
通讯作者：
Gardner, Annie
影响因子：
6.9
作者：
Cassettari, V. C.;da Silveira, I. R.;Menezes, P. R.
通讯作者：
Menezes, P. R.
影响因子：
--
作者：
Vijayakanthi N;Bahl D;Kaur N;Maria A;Dubey NK
通讯作者：
Dubey NK
影响因子：
3.7
作者：
Baek, Eun-Hwa;Kim, Se-Eun;Hwang, Inyeong
通讯作者：
Hwang, Inyeong