■抗生素抗性细菌使新生儿败血症的治疗方案复杂化,尤其是在发展中国家。这项研究确定了三级医院新生儿败血症的流行病学和细菌学特征,在尼日利亚西南部。
■这是一项从2017年12月至2019年4月在住院的临床新生儿败血症婴儿中进行的横断面研究。采用半自动系统进行血培养,通过半定量试剂盒检测脓毒症生物标志物(血清降钙素原),同时使用形式收集临床人口统计学数据.细菌鉴定,抗生素敏感性模式,确定介导抗性的遗传元件,通过标准方法和聚合酶链反应方案进行,分别。定量数据以频率表示,均值;双变量和多变量分析通过卡方或Fishers精确检验和逻辑回归进行。
■在入选的192例新生儿败血症中,42.7%(82/192)血培养阳性。与血培养阳性相关的因素包括呼吸频率≥60bpm(60/82;p<0.03),嗜睡/无意识(59/82;FE=7.76;p<0.001),咕噜呼吸(54/82;p=0.04),出生前胎粪通过(17/82;p=0.03)和胎膜长时间破裂≥24小时(50/82;FE=6.90;p=0.01)。另一方面,新生儿死亡率与升高的血清降钙素原测定(>0.5ng/mL)χ2=13.58;p=0.03]和革兰氏阴性菌血症(χ2=24.64;p<0.001)相关。最常见的细菌分离物是金黄色葡萄球菌(42/82),凝固酶阴性葡萄球菌属。(17/82),肠杆菌属。(8/82)和不动杆菌属。(6/82)。金黄色葡萄球菌85.7%(36/42)和凝固酶阴性葡萄球菌52.9%(9/17)存在甲氧西林耐药,而超广谱β-内酰胺酶(ESBL)和AmpC酶存在于(21.1%;4/19)革兰氏阴性杆菌中。
■在临床诊断的新生儿败血症病例中,几乎有一半有败血症的细菌病因学证实。革兰阴性菌血症和高血清降钙素原预测新生儿败血症死亡率在我们的环境中,对治疗新生儿败血症的常用抗生素有很高的耐药性。
UNASSIGNED: Antibiotic-resistant bacteria complicate treatment options in neonatal sepsis, especially in developing countries. This study determined the epidemiology and bacteriological characteristics of neonatal sepsis at a tertiary hospital, in southwest Nigeria.
UNASSIGNED: This was a cross-sectional study from December 2017 to April 2019 among admitted babies with clinical neonatal sepsis. Blood culture was performed by semi-automated system, sepsis biomarker assay (serum procalcitonin) by a semi-quantitative kit while proforma was used to capture clinico-demographic data. Bacterial identification, antibiotic susceptibility patterns, determination of genetic elements mediating resistance, were performed by standard methods and polymerase chain reaction protocols, respectively. Quantitative data were expressed as frequencies, mean; bivariate and multivariate analyses were performed by Chi-square or Fishers\' exact test and logistic regression.
UNASSIGNED: Of the 192 cases of neonatal sepsis enrolled, 42.7% (82/192) were blood culture positive. Factors associated with blood culture positivity included respiratory rate ≥60 bpm (60/82; p<0.03), lethargy/unconsciousness (59/82; FE=7.76; p<0.001), grunting respiration (54/82; p=0.04), meconium passage before birth (17/82; p=0.03) and prolonged rupture of membranes ≥24 hours (50/82; FE=6.90; p=0.01). On the other hand, mortality in the neonates was associated with elevated serum procalcitonin assay (>0.5 ng/mL) χ2=13.58; p=0.03] and Gram-negative bacteremia (χ2=24.64; p<0.001). The most common bacterial isolates were Staphylococcus aureus (42/82), coagulase-negative Staphylococcus spp. (17/82), Enterobacter spp. (8/82), and Acinetobacter spp. (6/82). Methicillin resistance was present in 85.7% (36/42) of Staphylococcus aureus and 52.9% (9/17) of coagulase-negative Staphylococcus, while extended-spectrum beta-lactamase (ESBL) and AmpC enzymes were present in (21.1%; 4/19) of the Gram-negative bacilli.
UNASSIGNED: Almost half of the cases of clinically diagnosed neonatal sepsis have bacterial etiologic confirmation of sepsis. Gram-negative bacteremia and high serum procalcitonin predict mortality in neonatal sepsis. There was high resistance to common antibiotics for the treatment of neonatal sepsis in our settings.