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低收入和中等收入国家新生儿被抗生素耐药病原体殖民化:系统性审查和元分析
Anne-Lise Beaumont1,2, Elsa Kermorvant-Duchemin3, Sébastien Breurec4,5,6,7
1Anti-Infective Evasion and Pharmacoepidemiology Team, Center for Epidemiology and Population Health, Université Paris-Saclay, UVSQ, INSERM, Montigny-le-Bretonneux, France.
JAMA network open
|November 5, 2024
概括
在LMIC中,新生儿与抗生素耐药细菌 (如第三代脑素耐药肠道细菌) (3GCRE) 的殖民是常见的. 医院分娩和新生儿使用抗生素增加了3GCRE殖民的风险,强调了预防策略的必要性.
科学领域:
- 医学微生物学 医学微生物学
- 公共卫生 公共卫生
- 传染性疾病 传染性疾病
背景情况:
- 在低收入和中等收入国家 (LMICs) 的新生儿细菌感染主要是由Enterobacterales和金黄色葡萄球菌引起的.
- 这些病原体是与抗菌素耐药性 (AMR) 相关的死亡的主要原因.
- 了解细菌殖民模式对于预防抗生素耐药新生儿败血症至关重要.
研究的目的:
- 综合有关第三代素耐药肠道细菌 (3GCRE),碳烯耐药肠道细菌 (CRE) 和甲素耐药黄金色细菌 (MRSA) 的流行情况和与殖民相关的因素的证据.
- 评估LMIC中新生儿和3个月以下婴儿的殖民性.
主要方法:
- 2000年至2024年间发表的研究的系统审查和元分析.
- 搜索了PubMed,Scopus,科学网和世卫组织全球指数医学.
- 包括来自LMICs报告3GCRE,CRE或MRSA殖民的患病率或相关因素在3个月以下的婴儿中的研究;不包括疫情报告.
主要成果:
- 3GCRE殖民的综合流行率为30.2%,在住院患者 (48.2%) 和非住院患者 (18.2%) 之间更高.
- CRE殖民的患病率为2.6%,MRSA殖民的患病率为2.7%.
- 3GCRE殖民的风险增加与医院分娩 (OR 1.87),新生儿使用抗生素 (OR 2.96) 和长时间膜破裂 (OR 3.86) 相关.
结论:
- 在LMICs的新生儿和幼儿中存在抗生素耐药性病原体殖民的大量流行.
- 研究之间的高度异质性限制了广泛的推断.
- 需要进一步的研究来确定传播途径,并制定针对新生儿败血症的有针对性的预防措施.
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