C反应蛋白指导下的新生儿疑诊早发型败血症抗生素治疗策略

C-reactive protein-guided antibiotic treatment strategy for neonates with suspected early-onset sepsis

摘要:

目的 探讨C反应蛋白指导疑诊新生儿早发型败血症（EOS）抗生素治疗的有效性和安全性。方法 2019年2~7月入住重庆医科大学附属儿童医院、胎龄 > 35周且疑诊EOS的新生儿为观察组（n=428），前瞻性观察抗生素治疗情况，若临床症状好转且连续两次CRP < 10 mg/L，考虑停用抗生素。2018年2~7月入住该院、胎龄 > 35周且疑诊EOS的患儿为对照组（n=328），回顾性分析其抗生素使用情况。对比两组抗生素使用时间、住院时间、感染反复发生率及临床转归等。结果 观察组抗生素使用时间及住院时间均较对照组短（P < 0.05）。两组感染反复发生率及临床转归的比较差异均无统计学意义（P > 0.05）。结论 C反应蛋白用于指导胎龄 > 35周、疑诊EOS新生儿的抗生素治疗策略，可缩短抗生素使用时间及住院时间，不增加感染反复的发生，可尝试临床推广。

Abstract:

Objective To evaluate the efficacy and safety of C-reactive protein (CRP)-guided antibiotic treatment strategy for neonates with suspected early-onset sepsis (EOS). Methods A total of 428 neonates, with a gestational age of > 35 weeks, who were admitted to the Children's Hospital of Chongqing Medical University from February to July, 2019 and were suspected of EOS were enrolled as the observation group. The effect of antibiotic treatment was prospectively observed, and if clinical symptoms were improved and CRP was < 10 mg/L in two consecutive tests, discontinuation of antibiotics was considered. A total of 328 neonates (gestational age of > 35 weeks) who were admitted to this hospital from February to July, 2018 and were suspected of EOS were enrolled as the control group, and the use of antibiotics was analyzed retrospectively. The two groups were compared in terms of duration of antibiotic treatment, length of hospital stay, incidence rate of repeated infection and clinical outcome. Results Compared with the control group, the observation group had significantly shorter duration of antibiotic treatment and length of hospital stay (P < 0.05). There were no significant differences in the incidence rate of repeated infection and clinical outcome between the two groups (P > 0.05). Conclusions For neonates with a gestational age of > 35 weeks and a suspected diagnosis of EOS, CRP-guided antibiotic treatment strategy can shorten duration of antibiotic treatment and length of hospital stay and does not increase the incidence rate of repeated infection. Therefore, it holds promise for clinical application.