南非医院的新生儿早期发病的血液感染
Genevieve Theron1, Adrie Bekker1, Larisse Bolton2
1Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 241, Cape Town, 8000, South Africa.
BMC infectious diseases
|January 20, 2025
概括
新生儿败血症 (EO-BSI) 是LMICs的一个主要威胁. 过早出生和低出生体重的婴儿面临更高的死亡风险,这些风险来自于格拉姆阴性病原体和无效的抗生素治疗.
科学领域:
- 新生儿医学 新生儿医学
- 传染性疾病 传染性疾病
- 在LMICs的公共卫生.
背景情况:
- 新生儿败血症,特别是早期发病的血液感染 (EO-BSI),是低收入和中等收入国家 (LMICs) 死亡的重要原因.
- 抗生素耐药性的上升降低了标准实证抗生素方案的疗效,如安培素加上对EO-BSI病原体的珍塔素.
- 这需要对这些环境中的致病原体和治疗有效性的最新理解.
研究的目的:
- 分析南非西开普省新生儿病房中早期发病的血液感染 (EO-BSI) 的病原体概况和经验性抗生素覆盖率.
- 确定与EO-BSI新生儿死亡率相关的因素,按医院类型分层 (中心与外围).
- 评估当前实证抗生素策略对流行EO-BSI病原体的有效性.
主要方法:
- 在南非 (2017-2018) 的9个新生儿病房 (3个中心,6个外围病房) 进行了血液培养确认的EO-BSI病例的回顾性分析.
- 审查临床和实验室记录以确定病原体分布,经验性抗生素覆盖率和死亡率预测指标.
- 根据医院类型对死亡率因素的分层分类,以确定特定的弱点.
主要成果:
- 总共有136个EO-BSI发作被确定,中央医院的发病率较高 (1.3/1000活产) 与外围医院的发病率相比 (0.5/1000活产).
- 早产 (68.3%) 和低出生体重 (61.8%) 的新生儿受到不成比例的影响. 主要的病原体包括Streptococcus agalactiae,Klebsiella pneumoniae,Listeria monocytogenes,Acinetobacter baumannii和埃舍里希亚大肠杆菌,这些病原体是主要的病原体.
- 经验性抗生素覆盖率在中央 (64%) 与外围医院 (84%) 相比较低. 格拉姆阴性EO-BSI和不一致的经验治疗显著增加了死亡风险 (分别是4倍和3倍).
结论:
- 早产和低出生体重的新生儿是最容易受到EO-BSI感染的群体.
- 格拉姆阴性病原体和与病原体易感性不一致的经验性抗生素治疗存在明显更高的死亡风险.
- 这些发现强调,需要改善LMIC新生儿败血症的诊断和治疗策略,考虑到局部耐药性模式和患者风险因素.
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