早产儿早发型败血症抗生素合理使用研究进展

Research advances in the rational use of antibiotics for early-onset sepsis in preterm infants

早产儿早发型败血症(EOS)发病率高,其起病隐匿,进展快,为避免严重并发症的发生,经验性抗生素长期应用的情况极为普遍,导致耐药菌株出现及早产儿不良结局发生风险明显增加。早产儿抗生素治疗的指征及疗程尚不统一。针对培养阴性且临床表现稳定的早产儿,及时停用经验性抗生素已成为共识。目前新生儿重症监护病房中抗生素治疗存在较大差异,需要制订合理的抗生素管理措施,包括根据EOS风险评估决定是否需要经验性抗生素治疗以及抗生素的选择和疗程的确定。早产儿的分娩特征为识别EOS风险较低的患儿提供了机会,并可能为启动或延长抗生素治疗的决定提供依据。本文总结当前早产儿EOS的流行病学以及抗生素应用情况,为优化抗生素管理提供参考。

The incidence of early-onset sepsis(EOS)in premature infants is high,characterized by insidious onset and rapid progression.To avoid the risk of severe complications,long-term use of empiric antibiotics is extremely common,leading to the emergence of drug-resistant strains and a significant increase in adverse outcomes among preterm neonates.The indications and course of antibiotic treatment for premature infants are not unified.In premature infants with negative bacterial culture results and stable clinical manifestations,empiric antibiotic therapy should be terminated in a timely manner.At present,there is significant difference in antibiotic treatment in neonatal intensive care unit,so it is necessary to formulate reasonable antibiotic management measures,including determining whether empirical antibiotic treatment is initiated according to EOS risk assessment,antibiotic selection and course of therapy.The delivery characteristics of premature infants provide an opportunity to identify children at lower risk for EOS,and may provide a basis for the decision to initiate or extend antibiotic therapy.This article summarized the current epidemiology and antibiotic application of EOS in premature infants,to provide reference for optimizing antibiotic management.