口服复方新诺明治疗新生儿耐药肠杆菌败血症9例病例系列报告  

9 cases of neonatal drug-resistant Enterobacteriaceae treated with oral SMZco:A case series report

作　　者：刘仕祺 杜娟 杨子馨 李耿 陈璐 齐宇洁 黑明燕 LIU Shiqi;DU Juan;YANG Zixin;LI Geng;CHEN Lu;QI Yujie;HEI Mingyan(Department of Neonatal Center,Beijing Children's Hospital,Capital Medical University,National Center for Children's Health,Beijing 100045,China)

机构地区：[1]国家儿童医学中心首都医科大学附属北京儿童医院新生儿中心,北京100045

出　　处：《中国循证儿科杂志》2022年第1期10-15,共6页Chinese Journal of Evidence Based Pediatrics

基　　金：北京市医院管理中心儿科协同发展中心儿科专项创新推广项目:XTCX201816;首都医科大学附属北京儿童医院管理课题项目:YGLY202003。

摘　　要：背景超说明书用药的情况在新生儿科非常普遍,基于耐药肠杆菌(CRE)败血症存在抗生素选择受限,复方新诺明(SMZco)可口服且其口服制剂的生物利用度较高,但说明书不建议在2月龄以下的婴儿中使用。目的总结口服SMZco治疗新生儿CRE败血症的经验和临床疗效。设计病例系列报告。方法通过医院药物管理系统,检索并申领同时符合以下条件的SMZco病历,2018年1月至2021年6月在首都医科大学附属北京儿童医院新生儿中心住院、入院时日龄≤28 d或矫正胎龄≤44周、住院期间CRE败血症诊断明确的病例,经新生儿医生、药师和儿科感染科会诊认为应用SMZco获益明显,不良反应可控;患儿家长接受医生建议,签署口服SMZco用药知情同意书。参考>2月龄儿童SMZco推荐剂量,观察用药期间过敏反应、胆红素脑病表现,每周监测血常规和肝肾功能。采集人口学信息,手术或深静脉置管史,有创通气时间,临床表现,标本培养阳性时间,菌种,药敏试验结果,口服SMZco时日龄、剂量,口服SMZco前后WBC、PLT和CRP,口服SMZco后不良反应和临床结局。主要结局指标好转出院和不良事件发生。结果9例口服SMZco的婴儿纳入分析,男5例,女4例;6例患儿的CRE败血症发生在手术后,8例有深静脉置管史;机械通气时间(793±381)h。标本类型:PICC管端和伤口分泌物各1例,单纯血2例,单纯痰3例、血+痰和血+脑脊液各1例。9例均接受>2周静脉广谱抗菌药物治疗;2例符合中枢神经系统感染诊断。获得CRE阳性培养结果为在我院住院39(23.5,49)d时,其中8例为肺炎克雷伯菌,1例为大肠埃希菌,均能产生超广谱β-内酰胺酶,对碳青霉烯类抗菌药物耐药;对阿米卡星耐药3例、敏感6例,对庆大霉素耐药5例、敏感4例,对环丙沙星耐药6例、敏感3例,对氯霉素中介2例、敏感7例,对四环素耐药3例、敏感5例、中介1例,对SMZco和替加环素均敏感。口服SMZco日龄�Background Off-label drug use is common in neonates.Appropriate and effective administration of antibiotics for Carbapenem-resistant Enterobacteriaceae(CRE)infection in neonates is challenging.Sulfamethoxazole compound(SMZco)can be taken orally with high bioavailability,however,it is not recommended to be used in infants under 2 months.Objective To summarize the experience and therapeutic effect of oral SMZco for the CRE septicemia in newborns.Design Case series report.Methods Through the hospital drug management system,SMZco medical records that meet the following criteria were collected:a.Patients were hospitalized in NICU of Beijing Children’s Hospital,Capital Medical University from January 2018 to June 2021;b.The age on admission was≤28 d or the corrected age was≤44 weeks;c.The CRE septicemia was confirmed by positive blood culture results and clinical manifestations.The oral SMZco as a combined use of medications was administered when the pros and cons were thoroughly discussed by neonatal physicians and clinical pharmacists,and formal written consents were signed by parents.The dose of SMZco was referred to that for children above 2 months old.Signs of allergy and manifestations of bilirubin encephalopathy had been closely watched during the treatment.Complete blood counting and reno-hepato-function were monitored weekly.The following information was collected:demographic characteristics,history of surgical intervention or long line catheterization,ventilation time,time interval between blood drawing and culture positive,species of the positive culture results together with the drug sensitivity test,age of starting SMZco administration,dosage of SMZco,WBC,PLT and CRP before and after SMZco treatment,adverse reactions and clinical outcomes.Main outcome measures Discharge after improvement.Results A total of 9 newborns with CRE septicemia were enrolled,among which 5 were males,6 received surgery intervention before CRE septicemia was confirmed,and 8 had history of long line catheterization.The average

关 键 词：复方新诺明 婴儿 新生 耐药肠杆菌 败血症 抗菌药物 

分 类 号：R722.1[医药卫生—儿科]