口服益生菌对早产儿肠道耐药菌定植的影响

Effect of oral administration of probiotics on intestinal colonization with drugresistant bacteria in preterm infants

摘要:

目的 探讨NICU 中早产儿口服益生菌对肠道耐药菌定植的影响。方法 将生后立即入住NICU的早产儿以是否母乳喂养分层后随机分组，试验组从开始胃肠内营养之日起添加益生菌喂养，对照组为空白对照。比较两组生后第1、3、7、14 天直肠拭子产超广谱β 内酰胺酶（ESBL）耐药菌筛查结果及疾病发生情况。结果 试验组（n=119）与对照组（n=138）在第1、3、7、14 天的直肠耐药菌定植及晚发性败血症、坏死性小肠结肠炎等疾病发生的差异均无统计学意义（P>0.05）。试验组非母乳喂养患儿生后第14 天的直肠耐药菌定植率明显低于对照组非母乳喂养儿（ 71.1% vs 88.9%，P=0.04）。未观察到益生菌使用相关不良反应发生。结论 早产儿使用益生菌一定条件下可能减少直肠耐药菌定植，且具有较高安全性。

Abstract:

Objective To evaluate the effect of oral administration of probiotics on intestinal colonization with drug-resistant bacteria among preterm infants in the neonatal intensive care unit (NICU). Methods A doubleblind, randomized, placebo-controlled trial was carried out in the preterm infants who were transferred to the NICU immediately after birth. These infants were stratified by whether they were breastfed and then randomized into test group and control group. The test group was given probiotics from the day when enteral feeding began, while the control group was treated conventionally without probiotics. The two groups were compared in terms of the colonization with extended-spectrum beta-lactamase-producing bacteria, as assessed by rectal swabs on days 1, 3, 7, and 14 after birth, and the incidence of diseases. Results Rectal colonization with drug-resistant bacteria was found in the test group (n=119) and control group (n=138) on days 1, 3, 7, and 14 after birth. There were no significant differences in the incidence of late-onset sepsis and necrotizing enterocolitis between the two groups (P>0.05). Among non-breastfed infants, the test group had significantly decreased rectal colonization with drug-resistant bacteria compared with the control group on day 14 after birth (71.1% vs 88.9%; P=0.04). No probiotic-related adverse events were observed in the study. Conclusions Oral administration of probiotics may reduce rectal colonization with drug-resistant bacteria in preterm infants under certain conditions and shows good safety.