对胎龄小于32周早产儿实施不同抗生素使用策略的评价

Evaluation of different antibiotic use strategies for preterm infants with gestational age less than 32 weeks

目的研究不同抗生素使用策略对胎龄<32周早产儿的临床疗效及对临床结局的影响。方法选取180例胎龄<32周的早产儿(实施抗生素使用策略改进治疗)为策略改进组,另以180例胎龄<32周早产儿(经验性抗生素治疗)为经验治疗组。2组均观察至早产儿出院或死亡。比较2组抗生素使用情况、早期粪便主要肠道菌群及观察期间医院感染发生情况、临床结局。结果①早期抗生素使用时间:策略改进组≤3 d、4~7 d占比高于经验治疗组,>7 d占比低于经验治疗组,P<0.05;②住院期间抗生素使用时间:策略改进组短于经验治疗组,P<0.05;③住院期间抗生素使用率:策略改进组低于经验治疗组,P<0.05。④早期粪便杆菌属、乳球菌属和肠球菌属占比:出生后3、5、7 d,2组均呈降低趋势,策略改进组更明显(P<0.05)。⑤观察期间,策略改进组总感染发生率及总不良结局发生率(5.00%、10.00%)均低于经验治疗组(11.11%、23.89%),P<0.05。结论胎龄<32周早产儿实施抗生素使用策略改进治疗,可有效改善早产儿抗生素使用情况,缓解早期粪便主要肠道菌群紊乱,降低医院感染发生情况,改善其临床结局,具有较好的治疗效果。

Objective To study the clinical efficacy of different antibiotic use strategies on preterm infants with gestational age less than 32 weeks and their effects on clinical outcomes.Methods 180 premature infants with gestational age less than 32 weeks(treated with antibiotic use strategy improvement)were selected as the strategy improvement group,and 180 premature infants with gestational age less than 32 weeks(treated with empirical antibiotics)were selected as the empirical treatment group.Both groups were observed until premature infants were discharged or died.The use of antibiotics,the main intestinal flora of early feces,the incidence of nosocomial infection and clinical outcomes during the observation period were compared between the 2 groups.Results①Early antibiotic use time:the proportion of≤3 days and 4-7 days in the strategy improvement group was higher than that in the empirical treatment group,and the proportion of>7 days was lower than that in the empirical treatment group(P<0.05).②Duration of antibiotic use during hospitalization:the strategy improvement group was shorter than the empirical treatment group,P<0.05;③Antibiotic use rate during hospitalization:the strategy improvement group was lower than the empirical treatment group,P<0.05.④Proportions of early fecal Bacillus,Lactococcus and Enterococcus:at 3,5 and 7 days after birth,the 2 groups showed a decreasing trend,and the strategy improvement group was more obvious(P<0.05).⑤During the observation period,the incidence of total infection and total adverse outcomes in the strategy improvement group(5.00%,10.00%)were lower than those in the empirical treatment group(11.11%,23.89%),P<0.05.Conclusion The improved treatment of antibiotic use strategy in premature infants with gestational age less than 32 weeks can effectively improve the use of antibiotics in premature infants,alleviate the disorder of main intestinal flora in early feces,reduce the incidence of nosocomial infection,and improve the clinical outcome,which has a good therapeutic effect.