败血症风险计算器指导下疑诊早发型败血症新生儿的抗生素管理

Sepsis risk calculator-guided antibiotic management in neonates with suspected early-onset sepsis

摘要:

目的 探讨败血症风险计算器（sepsis risk calculator，SRC）指导疑诊早发型败血症（early-onset sepsis，EOS）新生儿抗生素使用的有效性。方法 选取2019年3~7月于重庆医科大学附属儿童医院住院治疗的胎龄≥35周且疑诊EOS的患儿为对照组（n=284），收集病例资料，回顾性采用SRC给予对照组抗生素使用管理推荐；2020年7~11月入住该院、胎龄≥35周且疑诊EOS的新生儿为研究组（n=170），前瞻性使用SRC进行风险评分以辅助临床抗生素管理决策。分析两组抗生素使用率、血培养检验率、临床转归及SRC使用依从性等。结果 研究组出生时、入院时SRC评分均高于对照组（P < 0.05）；研究组抗生素使用率为84.7%（144/170），较对照组（91.5%，260/284）降低6.8%（P < 0.05），血培养检验率低于对照组（85.3% vs 91.9%，P < 0.05）；两组患儿不良临床转归发生率及最终EOS诊断情况比较差异均无统计学意义（P > 0.05）。结论 SRC的使用降低了疑诊EOS患儿经验性抗生素使用率，且未增加不良临床结局风险，可尝试临床推广。

Abstract:

Objective To evaluate the efficacy of sepsis risk calculator (SRC) in guiding antibiotic use in neonates with suspected early-onset sepsis (EOS). Methods A total of 284 neonates with a gestational age of ≥ 35 weeks were enrolled as the control group, who were hospitalized in the Children's Hospital of Chongqing Medical University from March to July, 2019 and were suspected of EOS. Their clinical data were retrospectively collected and the use of antibiotics was analyzed based on SRC. A total of 170 neonates with a gestational age of ≥ 35 weeks were enrolled as the study group, who were admitted to the hospital from July to November, 2020 and were suspected of EOS. SRC was used prospectively for risk scoring to assist the decision making of clinical antibiotic management. The two groups were compared in terms of the rate of use of antibiotics, blood culture test rate, clinical outcome, and adherence to the use of SRC. Results Compared with the control group, the study group had a significantly higher SRC score at birth and on admission (P < 0.05). The rate of use of antibiotics in the study group was significantly lower than that in the control group[84.7% (144/170) vs 91.5% (260/284), 6.8% decrease; P < 0.05]. The blood culture test rate in the study group was also significantly lower than that in the control group (85.3% vs 91.9%, P < 0.05). There was no significant difference between the two groups in the incidence rate of adverse outcomes and the final diagnosis of EOS (P > 0.05). Conclusions The use of SRC reduces the rate of empirical use of antibiotics in neonates with suspected EOS and does not increase the risk of adverse outcomes, and therefore, it holds promise for clinical application.