PDF(Pubmed)
Abstract：
Sepsis is a common disease with high morbidity and mortality among newborns in intensive care units world-wide. Gram-negative bacillary bacteria are the major source of infection in neonates. Gentamicin is the most widely used aminoglycoside antibiotic in empiric therapy against early-onset sepsis. However, therapy failure may result due to various factors. The purpose of this study was to identify predictors of gentamicin therapy failure in neonates with sepsis. This was a prospective cross-sectional study at the Neonatal Intensive Care Unit at Windhoek Central Hospital over a period of 5 months in 2019. Neonates received intravenous gentamicin 5 mg/kg/24 h in combination with either benzylpenicillin 100 000 IU/kg/12 h or ampicillin 50 mg/kg/8 h. Logistic regression modeling was performed to determine the predictors of treatment outcomes. 36% of the 50 neonates were classified as having gentamicin treatment failure. Increasing treatment duration by 1 day resulted in odds of treatment failure increasing from 1.0 to 2.41. Similarly, one unit increase in CRP increases odds of gentamicin treatment failure by 49%. The 1 kg increase in birthweight reduces the log odds of treatment failure by 6.848, resulting in 99.9% decrease in the odds of treatment failure. One unit increase in WBC reduces odds of gentamicin treatment failure by 27%. Estimates of significant predictors of treatment failure were precise, yielding odds ratios that were within 95% confidence interval. This study identified the following as predictors of gentamicin therapy failure in neonates: prolonged duration of treatment, elevated C-reactive protein, low birthweight, and low white blood cell count.
摘要：
脓毒症是全球重症监护病房新生儿中发病率和死亡率高的常见疾病。革兰阴性杆菌是新生儿的主要感染源。庆大霉素是最广泛使用的氨基糖苷类抗生素，用于经验性治疗早发性败血症。然而,由于各种因素可能导致治疗失败。这项研究的目的是确定脓毒症新生儿庆大霉素治疗失败的预测因素。这是2019年温得和克中心医院新生儿重症监护病房的一项前瞻性横断面研究，为期5个月。新生儿静脉注射庆大霉素5mg/kg/24h联合苄青霉素100000IU/kg/12h或氨苄西林50mg/kg/8h。进行Logistic回归建模以确定治疗结果的预测因素。50例新生儿中有36％被归类为庆大霉素治疗失败。治疗持续时间增加1天导致治疗失败的几率从1.0增加到2.41。同样，CRP增加1个单位,庆大霉素治疗失败的几率增加49%.出生体重增加1kg将治疗失败的对数几率降低6.848,导致治疗失败的几率降低99.9%。WBC增加一个单位将庆大霉素治疗失败的几率降低27%。治疗失败的重要预测因素的估计是精确的，在95%置信区间内的屈服比值比.这项研究确定了以下因素作为新生儿庆大霉素治疗失败的预测因素：治疗持续时间延长，C反应蛋白升高，低出生体重,白细胞计数低.
