产前使用抗生素与早产儿早发型及晚发型败血症关系的研究

Abstract

Abstract: 　Objective　To investigate the incidence and pathogen distribution of early-onset sepsis (EOS) and later-onset sepsis (LOS) in preterm infants exposed to antenatal antibiotics. Methods The singleton preterm infants with gestational age ≤ 33 weeks who were admitted to our hospital within 24 hours after birth and had stayed for more than 24 hours were selected from Jan. 2010 to Dec. 2012. According to the exposure time of antenatal antibiotics, infants were divided into antibiotics group (≥4 hours) and control group (<4 hours). The proportion of EOS and LOS and pathogen distribution were compared between two groups. Results A total of 629 preterm infants, 232 in antibiotics group and 397 in control group, were selected. Compared with control group, the birth weight, percentages of clinical chorioamnionitis, prenatal hormone exposure > 24 h and EOS were significantly higher while percentages of asphyxia and respiratory distress syndrome (RDS) were significantly lower in antibio-tics group (P<0.05). There was no difference in the occurrence of LOS between two groups (P>0.05). In 29 cases of EOS, 5 cases (17.2%) were complicated by suppurative meningitis. There were 16 cases of EOS in antibiotics group. Positive blood culture was found in 11 cases (68.8%) including 6 Gram-positive (G⁺) and 5 Gram-negative (G^-) bacteria. There were 13 cases of EOS in control group. Positive blood culture was found in 5 cases (38.5%) including 4 Gram-negative (G^-) and 1 Gram-positive (G⁺) bacteria. Non-resistant bacteria were dominant in two groups and there was no difference in positive rate of blood culture and proportion of G⁺ bacteria between two groups (P>0.05). In 75 cases of LOS, 5 cases (6.7%) were complicated by suppurative meningitis. There was no difference in incidence of meningitis between EOS and LOS cases (P>0.05). There were 29 cases of LOS in antibiotics group. Positive blood culture was found in 17 cases (58.6%) including 6 Gram-positive (G⁺) and 9 Gram-negative (G^-) bacteria and 2 fungi. There were 46 cases of LOS in control group. Positive blood culture was found in 23 cases (50.0%) including 14 Gram-positive (G⁺) and 8 Gram-negative (G^-) bacteria and 1 fungus. Drug-resistant bacteria were dominant in two groups and there was no difference in positive rate of blood culture and proportion of G⁺ bacteria between two groups (P>0.05). Conclusions Antenatal antibiotics exposure was not effective to either reduce the occurrence of EOS and LOS or change the distribution of pathogens in EOS and LOS in preterm infants.

ZHU Meiying . Relationship of antenatal antibiotic exposure with early-onset or late-onset sepsis in preterm infants[J]., 2014, 32(4): 330-335.

References

[1] Soraisham AS，Singhal N，McMillan DD，et al.A multicenter study on the clinical outcome of chorioamnionitis in preterm infants [J]. Am J Obstet Gynecol，2009，200(4)：e1-e6.
[2] Paolucci M，Landini MP，Sambri V. How can the microbiologist help in diagnosing neonatal sepsis ? [J]. Int J Pediatr，2012：120139.
[3] Stoll BJ，Hansen NI，Sanchez PJ，et al. Early onset neonatal sepsis：the burden of group B streptococcal and E.coli disease continues [J]. Pediatrics，2011，127(5)：817-826.
[4] Kuhn P，Dheu C，Bolender C，et al. Incidence and distribution of pathogens in early-onset neonatal sepsis in the era of antenatal antibiotics[J]. Paediatric Perinat Epidemiol ，2010，24(5)：479-487.
[5] Koening JM，Keenan WJ. Group B streptococcus and early-onset sepsis in the era of maternal prophylaxis [J]. Pediatr Clin North Am，2009，56(3)：689-708.
[6] Asindi AA，Archibong EI，Mannan NB. Mother-infant colonization and neonatal sepsis in prelabor rupture of membranes [J]. Saudi Med J，2002，23(10)：1270-1274.
[7] Cousens S，Blencowe H，Gravett M，et al. Antibiotics for pre-term pre-labour rupture of membranes：prevention of neonatal deaths due to complications of pre-term birth and infection [J]. Int J Epidemiol，2010，39 (Suppl 1)：i134-i143.
[8] Edwards RK，Clark P，Sistrom CL，et al. Intrapartum antibiotic prophylaxis 1：relative effects of recommended antibiotics on gram-negative pathogens [J]. Obstet Gynecol，2002，100（3）：534-539.
[9] 中华医学会妇产科学分会产科学组. 早产的临床诊断与治疗推荐指南（草案） [J]. 中华妇产科杂志，2007，42(7)：498-500.
[10] 余加林，吴仕孝.新生儿败血症诊疗方案 [J]. 中华儿科杂志，2003，41(41)：897-899.
[11] 刘春峰.小儿重症肺炎并发症的诊治进展 [J]. 小儿急救医学，2004，11(1)：11-13.
[12] Fishman SG，Gelber SE. Evidence for the clinical management of chorioamnionitis [J]. Semin Fetal Neonatal Med，2012，17(1)：46-50.
[13] Pisani V，Bizzarri B，Cardi V，et al. Early onset sepsis in very low birth weight newborn infants [J]. J Matern Fetal Neonatal Med，2012，25 Suppl 3：21-25.
[14] Mukhopadhyay S，Puopolo KM. Risk assessment in neonatal early onset sepsis[J]. Semin Perinatol，2012，36(6)：408-415.
[15] Tamelien? R1，Bar?ait? E，Stonien? D，et al. Escherichia coli colonization in neonates：prevalence，perinatal transmission，antimicrobial susceptibility，and risk factors [J]. Medicina (Kaunas)，2012，48(2)：71-76.
[16] Cobo T，Kacerovsky M，Palacio M，et al. Intra-amniotic inflammatory response in subgroups for women with preterm prelabor rupture of the membranes [J]. PLoS One，2012； 7(8)：e43677.
[17] DiGiulio DB，Romero R，Kusanovic JP，et al. Prevalence and diversity of microbes in the amniotic fluid，the fetal inflammatory response，and pregnancy outcome in women with preterm pre-labor rupture of membranes [J]. Am J Reprod Immunol，2010，64(1)：38-57.
[18] DiGiulio DB.Diversity of microbes in amniotic fluid [J]. Semin Fetal Neonatal Med，2012，17(1)：2-11.
[19] Wolfs TG，Jellema RK，Turrisi G，et al. Inflammation-induced immune suppression of the fetus：a potential link between chorioamnionitis and postnatal early onset sepsis [J]. J Matern Fetal Neonatal Med，2012，25（Suppl）1：8-11.
[20] Escbar GJ，li DK，Armstrong MA，et al. Neonatal sepsis workups in infants >/=2000 grams at birth：A population-based study [J]. Pediatrics，2000，106(2pt1)：256-263.
[21] Mercer B. Antibiotics in the management of PROM and preterm labor [J]. Obstet Gynecol Clin North Am，2012，39(1)：65-76.
[22] Sgro M，Shah PS，Campbell D，et al. Early-onset neonatal sepsis：rate and organism pattern between 2003 and 2008 [J].J Perinatol，2011，31(12)：794-798.
[23] Maayan-Metzger A，Barzilai A，Keller N，et al.Are the “good old” antibiotics still appropriate for early-onset neonatal sepsis? A 10 year survey [J]. Isr Med Assoc J，2009，11(3)：138-142.
[24] Schrag SJ，Hadler JL，Arnold KE，et al. Risk factors for invasive，early-onset Escherichia coli infections in the era of widespread intrapartum antibiotic use [J]. Pediatrics，2006，118(2)：570-576.
[25] Puopolo KM，Eichenwald EC. No change in the incidence of ampicillin-resistant，neonatal，early-onset sepsis over 18 years[J].Pediatrics，2012，125(5)：e1031-1038.
[26] Bromiker R，Ernest N，Meir MB，et al. Correlation of bacterial type and antibiotic sensitivity with maternal antibiotic exposure in early-onset neonatal sepsis [J]. Neonatology，2013，103(1)：48-53.
[27] Bizzarro MJ，Dembry LM，Baltimore RS，et al. Changing patterns in neonatal Escherichia coli sepsis and ampicillin resistance in the era of intrapartum antibiotic prophylaxis [J]. Pediatrics，2008，121(4)：689-696.
[28] Wright AJ，Unger S，Coleman BL，et al. Maternal antibiotic exposure and risk of antibiotic resistance in neonatal early-onset sepsis：a case-cohort study [J]. Pediatr Infect Dis J，2012，31(11)：1206-1208.
[29] Lin CY，Hsu CH，Huang FY，et al. The changing face of early-onset neonatal sepsis after the implementation of a maternal group B streptococcus screening and intrapartum prophylaxis policy-a study in one medical center [J]. Pediatr Neonatol，2011，52(2)：78-84.
[30] Wójkowska-Mach J，Borszewska-Kornacka M，Domańska J，et al. Early-onset infections of very-low-birth-weight infants in Polish neonatal intensive care units [J]. Pediatr Infect Dis J，2012，31(7)：691-695.
[31] Vergnano S，Menson E，Kennea N，et al. Neonatal infections in England：the NeonIN surveillance network [J]. Arch Dis Child Fetal Neonatal Ed，2011，96(1)：F9-F14.
[32] Shane AL，Stoll BJ. Recent developments and current issues in the epidemiology，diagnosis，and management of bacterial and fungal neonatal sepsis [J]. Am J Perinatol，2013，30(2)：131-141.
[33] Strunk T，Doherty D，Jacques A，et al. Histologic chorioamnionitis is associated with reduced risk of late-onset sepsis in preterm infants [J]. Pediatrics，2012，129(1)：e134-141.
[34] Wynn Jl，Hansen NI，Das A，et al. Early sepsis does not increase the risk of late sepsis in very low birth weight neonates [J]. J Pediatr，2013，162(5)：942-948.
[35] Lin CB，Hornik CP，Clark R，et al. Very low birth weight neonates who survive early-onset sepsis do not have an increased risk of developing late-onset sepsis [J]. Early Hum Dev，2012，88(11)：905-909.
[36] Bizzarro MJ，Raskind C，Baltimore RS，et al. Seventy-five years of neonatal sepsis at Yale：1928-2003 [J]. Pediatrics，2005，116(3)：595-602.

Relationship of antenatal antibiotic exposure with early-onset or late-onset sepsis in preterm infants

PDF (PC)

Like

Knowledge

Cited

Abstract

Cite this article

share this article

References

Related Articles 0

Metrics

Comments

Recommended 0