Incidence and distribution of pathogens in early-onset neonatal sepsis in the era of antenatal antibiotics
Incidence and distribution of pathogens in early-onset neonatal sepsis in the era of antenatal antibiotics
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DOI：
10.1111/j.1365-3016.2010.01132.x
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发表时间：
2010-09-01
影响因子：
2.8
通讯作者：
Astruc, Dominique
中科院分区：
文献类型：
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作者：
Kuhn, Pierre;Dheu, Celine;Astruc, Dominique
P>Kuhn P，Dheu C，Bolender C，Chognot D，Keller L，Demil H，Donato L，Langer B，Messer J，Astruc D.产前抗生素时代早发性新生儿败血症病原体的发病率和分布。2001年，法国发布了一套新的产前抗生素使用指南（AA）。这些指南建议分娩期预防性抗生素（IAP）预防B族链球菌（GBS）疾病，并建议在发生早产胎膜早破时使用AA延长妊娠时间（PPROM的AA）。本研究的目的是确定AA的影响，建议由国家指南，发病率和病原体的分布在早发性新生儿败血症（EONS）。我们进行了一项以人群为基础的，前瞻性的，观察性研究的II级和III级围产期中心整个地区的阿尔萨斯，法国东北部地区，2004年3月至2005年2月。研究人群包括所有确诊或可能患有EONS的新生儿，他们接受了至少5天的抗生素治疗。我们分析了AA暴露以及从医疗记录中获得的临床和微生物数据。在研究期间，共有20131名新生儿出生，其中217名被纳入研究。其中，24例受试者确诊为脓毒症，140例很可能为脓毒症，53例可能为EONS。经证实的EONS的总发生率为每1000例分娩1.19例。在24例确诊的EONS病例中有15例（62.5%）感染细菌为GBS（发病率：0.75/1000例分娩），在140例可能的败血症病例中有81例（58%）感染细菌为GBS。在24例确诊的EONS病例中的6例（25%）（发病率：0.3/1000例分娩）和140例临床脓毒症病例中的30例（21%）中鉴定出大肠埃希菌。在E.大肠埃希菌感染（n = 36）、阿莫西林耐药（n = 18）与AA使用有统计学关联（P = 0.045）。这种联系在PPROM病例中具有显著性（P = 0.015），但在使用IAP预防GBS疾病时则无显著性（P = 0.264）。60例中有18例（30%）未行IAP，93例中有32例（34%）未行IAP，尽管筛查阳性或存在EONS的危险因素。耐氨基青霉素E.大肠杆菌感染似乎与PPROM病例中AA延长有关，并且似乎优先影响早产儿。因此，产后治疗策略应考虑这种可能的影响。我们的数据表明，目前的GBS产妇预防政策与病原体耐药性的过度风险无关。考虑到本地区GBS EONS的高发病率，更好地遵守指南可能会取得进展。这些结果加强了继续监测的必要性。
P>Kuhn P, Dheu C, Bolender C, Chognot D, Keller L, Demil H, Donato L, Langer B, Messer J, Astruc D. Incidence and distribution of pathogens in early-onset neonatal sepsis in the era of antenatal antibiotics. Paediatric and Perinatal Epidemiology 2010.In 2001 France issued a new set of guidelines for the use of antenatal antibiotics (AA). These guidelines recommended intrapartum antimicrobial prophylaxis (IAP) to prevent group B streptococcal (GBS) disease and AA to prolong pregnancy in the event of preterm premature rupture of membranes (AA for PPROM). This study aims to determine the effects of AA, recommended by national guidelines, on the incidence and distribution of pathogens in early-onset neonatal sepsis (EONS).We performed a population-based, prospective, observational study of level II and III perinatal centres throughout the region of Alsace, a northeastern area of France, between March 2004 and February 2005. The study population included all neonates with confirmed or probable EONS, who were treated with antibiotics for at least 5 days. We analysed exposure to AA, as well as clinical and microbiological data obtained from medical records. A total of 20 131 neonates were born during the study period, and 217 were included in the study. Of these, 24 subjects had confirmed sepsis, 140 had probable sepsis and 53 had possible EONS. The overall incidence of confirmed EONS was 1.19 per 1000 births. The infecting bacteria was GBS in 15 of 24 (62.5%) confirmed EONS cases (incidence: 0.75 per 1000 births) and in 81 of 140 (58%) probable sepsis cases. Escherichia coli was identified in 6 of 24 (25%) cases of confirmed EONS (incidence: 0.3 per 1000 births) and in 30 of 140 (21%) cases of clinical sepsis. Among E. coli infections (n = 36), amoxicillin resistance (n = 18) was statistically linked with AA use (P = 0.045). This link was significant in cases of PPROM (P = 0.015), but not when IAP was administered to prevent GBS disease (P = 0.264). IAP was not performed in 18 of 60 (30%) cases and 32 of 93 (34%) cases, despite positive screening or the presence of risk factors for EONS, respectively.Group B streptococcus remains the predominant pathogen in the era of AA. Aminopenicillin-resistant E. coli infections seem to be linked to prolonged AA in cases of PPROM and appear to preferentially affect preterm infants. Therefore, postnatal treatment strategies should consider this possible effect. Our data indicate that the current policy of GBS maternal prophylaxis is not associated with an excessive risk of pathogen resistance. Considering the high incidence of GBS EONS in our region, possible progress could result from better observance of guidelines. These results strengthen the need for continuation of surveillance.