经验性抗生素治疗时间与低出生体重婴儿发生不良事件的相关性

Correlation between empiric antibiotical treatment time and adverse events in low birth weight infants

目的探讨经验性抗生素使用时间与低出生体重儿发生不良事件的相关性。方法选取2017年1月至2019年6月湖北省十堰市太和医院新生儿重症监护病房(NICU)收治的未经血培养证实的115例低出生体重且疑似新生儿早发型败血症患儿为研究对象,按照经验性抗生素治疗时间分为A组(2~4天,n=57)和B组(5~7天,n=58),比较两组患儿临床资料;按照不良事件发生情况分为不良事件组(n=29)和对照组(n=86),采用多因素Logistic回归分析患儿出现不良事件的危险因素。结果A组患儿出生体重、出生孕周及新生儿5min Apgar评分>6分比例高于B组,差异具有统计学意义(t/χ^(2)值分别为4.067、4.932、6.219,P<0.05),其他资料差异均无统计学意义(P>0.05);A组患儿不良事件(死亡、严重神经系统损伤、早产儿视网膜病变、坏死性小肠结肠炎、医院获得性感染)总发生率低于B组,差异具有统计学意义(χ^(2)=5.323,P<0.05);多因素Logistic回归分析结果显示,抗生素使用时间5~7天、胎膜早破时间>24h、5min Apgar评分≤6分是影响低出生体重患儿不良事件的危险因素(OR值分别为24.226、24.961、77.054,P<0.05),出生体重较高是影响患儿不良事件的保护性因素(OR=0.995,P<0.05)。结论出生后细菌培养阴性的低出生体重儿使用经验性抗生素治疗的时间与发生严重不良后果相关,在临床实践中应减少经验性使用抗生素时间。

Objective To explore correlation between duration of empirical antibiotic use and adverse events in low birth weight infants.Methods 115 children with low birth weight and were suspected as neonatal early-onset sepsis(EOS)who admitted to Neonatal Intensive Care Unit(NICU)of Taihe Hospital in Shiyan city,Hubei province without blood culture confirmation from January 2017 to June 2019 were selected as research subjects.According to empirical antibiotic treatment time,they were divided into group A(2-4 days,n=57)and group B(5-7 days,n=58).The clinical data of the infants between the two groups were compared.According to whether the infant had adverse events or not,the infants were divided into adverse events group(n=29)and no adverse events group(control group)(n=86).Multivariate logistic regression analysis was used to analyze risk factors for adverse events of the infants.Results In group A,birth weight,gestational age at birth and proportion of infants with 5 min Apgar score>6 points were higher than those in group B,and the differences were statistically significant(t/χ^(2)=4.067,4.932 and 6.219 respectively,all P<0.05).While in other data,the differences between the two groups were not statistically significant(all P>0.05).The total incidence of adverse events[death,severe nervous system damage,retinopathy of prematurity(ROP),necrotizing enterocolitis(NEC),hospital-acquired infection]in group A was lower than in group B,and the difference was statistically significant(χ^(2)=5.323,P<0.05).Multivariate logistic regression analysis showed that antibiotic use time of 5-7 days,elapsed time of premature rupture of membranes(PROM)>24 h,5 min Apgar score≤6 points were risk factors for adverse events in the infants with low birth weight(OR=24.226,24.961 and 77.054 respectively,all P<0.05).Higher birth weight was a protective factor for adverse events in the infants(OR=0.995,P<0.05).Conclusion Long time of empirical antibiotic treatment for low birth weight infants with negative bacterial culture results after birth is related to occurrence of serious adverse consequences.In clinical practice,use time of empirical antibiotics should be shortened.