兒童膿毒癥抗感染治療的研究進展_West China Medical Journal

Authors：

高滬 ,  李熙鴻

四川大學華西第二醫院急診科/出生缺陷與相關婦兒疾病教育部重點實驗室（成都 ?610041）;

Corresponding?author：

李熙鴻, Email: hilixihong@163.com

Keywords：

兒童; 膿毒癥; 抗感染

DOI：

10.7507/1002-0179.201507105

Video：

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膿毒癥是由感染導致的全身炎性反應，為兒科常見急危重癥，是全球嬰幼兒死亡的最主要原因。早期、適當、充分的抗感染治療可有效阻止疾病進展，提高患兒生存率，但面對抗菌藥物濫用、耐藥菌增多，流行病學資料缺乏等現象，如何高效合理地開展膿毒癥患者的抗感染治療、提高搶救成功率面臨巨大挑戰，尤其是針對兒童這類特殊用藥群體。該文從膿毒癥定義、病原菌分布與耐藥性、感染源控制、合理抗感染等多個方面對近年來國內外兒童膿毒癥抗感染治療的研究進展進行簡要綜述，從而為臨床治療提供決策依據。

Citation： 高滬, 李熙鴻. 兒童膿毒癥抗感染治療的研究進展. West China Medical Journal, 2017, 32(5): 786-789. doi: 10.7507/1002-0179.201507105 Copy

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2.	Institute for Health Metrics and Evaluation. GBD Compare. 2015[2017-03-01]. .
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4.	Filbin MR, Arias SA, Camargo CA, et al. Sepsis visits and antibiotic utilization in U. S. emergency departments. Crit Care Med, 2014, 42(3): 528-535.
5.	畢凌云, 趙德安, 韓子明. 兒童嚴重膿毒癥的認識現狀. 醫學與哲學, 2012, 33(6): 53-54.
6.	Dellinger RP, Levy MM, Rhodes A, et al. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med, 2013, 41(2): 580-637.
7.	楊虎. 兒童膿毒癥發病機制及診治進展. 國際兒科學雜志, 2014, 41(2): 138-141.
8.	臧婉, 鄧少麗. 新生兒血培養 541 例病原菌分布及藥敏試驗結果分析. 現代醫藥衛生, 2014, 30(1): 11-13, 16.
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14.	蔡小慧, 呂星, 卿之駒. 兒童血培養的病原菌分布及耐藥性分析. 國際檢驗醫學雜志, 2012, 33(13): 1613-1614, 1617.
15.	Ganatra HA, Zaidi AK. Neonatal infections in the developing world. Semin Perinatol, 2010, 34(6): 416-425.
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18.	Nygard ST, Langeland N, Flaatten HK, et al. Aetiology, antimicrobial therapy and outcome of patients with community acquired severe sepsis: a prospective study in a Norwegian university hospital. BMC Infect Dis, 2014, 4(14): 121.
19.	Agarwal R, Schwartz DN. Procalcitonin to guide duration of antimicrobial therapy in intensive care units: a systematic review. Clin Infect Dis, 2011, 53(4): 379-387.
20.	Paul M, Shani V, Muchtar E, et al. Systematic review and meta-analysis of the efficacy of appropriate empiric antibiotic therapy for sepsis. Antimicrob Agents Chemother, 2010, 54(11): 4851-4863.
21.	Kumar A, Safdar N, Kethireddy S, et al. A survival benefit of combination antibiotic therapy for serious infections associated with sepsis and septic shock is contingent only on the risk of death: a meta-analytic / metaregression study. Crit Care Med, 2010, 38(8): 1651-1664.
22.	Jalili M, Barzegari H, Pourtabatabaei N, et al. Effect of door-to-antibiotic time on mortality of patients with sepsis in emergency department: a prospective cohort study. Acta Med Iran, 2013, 51(7): 454-460.
23.	Ferrer R, Martin-Loeches I, Phillips G, et al. Empiric antibiotic treatment reduces mortality in severe sepsis and septic shock from the first hour: results from a guideline-based performance improvement program. Crit Care Med, 2014, 42(8): 1749-1755.
24.	Randolph AG, Mcculloh RJ. Pediatric sepsis: important considerations for diagnosing and managing severe infections in infants, children, and adolescents. Virulence, 2014, 5(1): 179-189.
25.	Duszyńska W. Strategies of empiric antibiotic therapy in severe sepsis. Anaesthesiol Intensive Ther, 2012, 44(2): 96-103.
26.	Kumar A, Safdar N, Kethireddy S, et al. A survival benefit of combination antibiotic therapy for serious infections associated with sepsis and septic shock is contingent only on the risk of death: a meta-analytic/meta-regression study. Crit Care Med, 2010, 38(8): 1651-1664.
27.	Skorup P, Maudsdotter L, Lipcsey M, et al. Beneficial antimicrobial effect of the addition of an aminoglycoside to a β-lactam antibiotic in anE. coli porcine intensive care severe sepsis model. PLoS One, 2014, 9(2): e90441.
28.	Paul M1, Lador A, Grozinsky-Glasberg S, et al. Beta lactam antibiotic monotherapyversus beta lactam-aminoglycoside antibiotic combination therapy for sepsis. Cochrane Database Syst Rev. 2014, 7(1): CD003344.
29.	Horisberger T, Harbarth S, Nadal D, et al. G-CSF and IL-8 for early diagnosis of sepsis in neonates and critically ill children-safety and cost effectiveness of a new laboratory prediction model: study protocol of a randomized controlled trial [ISRCTN91123847]. Crit Care, 2004, 8(6): R443-R450.
30.	Dimopoulos G, Poulakou G, Pneumatikos IA, et al. Short-vs long-duration antibiotic regimens for ventilator-associated pneumonia: a systematic review and meta-analysis. Chest, 2013, 144(6): 1759-1767.
31.	Oliveira CF, Botoni FA, Oliveira CR, et al. Procalcitoninversus C-reactive protein for guiding antibiotic therapy in sepsis: a randomized trial. Crit Care Med, 2013, 41(10): 2336-2343.
32.	Dellinger RP, Levy MM, Carlet JM, et al. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2008. Intensive Care Med, 2008, 34(1): 17-60.
33.	Bouadma L, Luyt CE, Tubach F, et al. Use of procalcitonin to reduce patients’ exposure to antibiotics in intensive care units (PRORATA trial): a multicentre randomised controlled trial. Lancet, 2010, 375(9713): 463-474.
34.	Schuetz P, Chiappa V, Briel M, et al. Procalcitonin algorithms for antibiotic therapy decisions: a systematic review of randomized controlled trials and recommendations for clinical algorithms. Arch Intern Med, 2011, 171(15): 1322-1331.
35.	黃彩芝, 莫麗亞, 李先斌, 等. 不同細菌感染所致膿毒癥患兒血清降鈣素原水平的研究. 國際檢驗醫學雜志, 2010, 31(10): 1110-1111.

1. ?Wiens MO, Kumbakumba E, Kissoon N, et al. Pediatric sepsis in the developing world: challenges in defining sepsis and issues in post-discharge mortality. Clin Epidemiol, 2012, 2012(4): 319-325.
2. Institute for Health Metrics and Evaluation. GBD Compare. 2015[2017-03-01]. .
3. Black RE, Cousens S, Johnson HL, et al. Global, regional, and national causes of child mortality in 2008: a systematic analysis. Lancet, 2010, 375(9730): 1969-1987.
4. Filbin MR, Arias SA, Camargo CA, et al. Sepsis visits and antibiotic utilization in U. S. emergency departments. Crit Care Med, 2014, 42(3): 528-535.
5. 畢凌云, 趙德安, 韓子明. 兒童嚴重膿毒癥的認識現狀. 醫學與哲學, 2012, 33(6): 53-54.
6. Dellinger RP, Levy MM, Rhodes A, et al. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med, 2013, 41(2): 580-637.
7. 楊虎. 兒童膿毒癥發病機制及診治進展. 國際兒科學雜志, 2014, 41(2): 138-141.
8. 臧婉, 鄧少麗. 新生兒血培養 541 例病原菌分布及藥敏試驗結果分析. 現代醫藥衛生, 2014, 30(1): 11-13, 16.
9. Acquah SE, Quaye L, Sagoe K, et al. Susceptibility of bacterial etiological agents to commonly-used antimicrobial agents in children with sepsis at the Tamale Teaching Hospital. BMC Infect Dis, 2013, 18(13): 89.
10. Ramasamy S, Biswal N, Bethou A, et al. Comparison of two empiric antibiotic regimen in late onset neonatal sepsis--a randomized controlled trial. J Trop Pediatr, 2014, 60(1): 83-86.
11. Li Z, Xiao Z, Li Z, et al. 116 cases of neonatal early-onset or late-onset sepsis: a single center retrospective analysis on pathogenic bacteria species distribution and antimicrobial susceptibility. Int J Clin Exp Med, 2013, 6(8): 693-699.
12. 吳茜, 肖曙芳, 李斌, 等. 2009～2011 年昆明兒童醫院小兒敗血癥病原菌及耐藥分析. 中華臨床醫師雜志: 電子版, 2013, 7(13): 6090-6092.
13. 侯宏, 高嶺, 王霞, 等. 2009 至 2011 年南京地區兒童血培養中病原菌的分布及耐藥性分析. 檢驗醫學, 2013, 28(11): 1030-1033.
14. 蔡小慧, 呂星, 卿之駒. 兒童血培養的病原菌分布及耐藥性分析. 國際檢驗醫學雜志, 2012, 33(13): 1613-1614, 1617.
15. Ganatra HA, Zaidi AK. Neonatal infections in the developing world. Semin Perinatol, 2010, 34(6): 416-425.
16. 趙靜, 熊濤, 唐軍, 等. 早發型和晚發型新生兒膿毒癥的臨床特點. 實用兒科臨床雜志, 2012, 27(10): 736-738.
17. Le Doare K, Bielicki J, Heath PT, et al. Systematic review of antibiotic resistance rates among Gram-negative bacteria in children with sepsis in resource-limited countries. J Pediatric Infect Dis Soc, 2015, 4(1): 11-20.
18. Nygard ST, Langeland N, Flaatten HK, et al. Aetiology, antimicrobial therapy and outcome of patients with community acquired severe sepsis: a prospective study in a Norwegian university hospital. BMC Infect Dis, 2014, 4(14): 121.
19. Agarwal R, Schwartz DN. Procalcitonin to guide duration of antimicrobial therapy in intensive care units: a systematic review. Clin Infect Dis, 2011, 53(4): 379-387.
20. Paul M, Shani V, Muchtar E, et al. Systematic review and meta-analysis of the efficacy of appropriate empiric antibiotic therapy for sepsis. Antimicrob Agents Chemother, 2010, 54(11): 4851-4863.
21. Kumar A, Safdar N, Kethireddy S, et al. A survival benefit of combination antibiotic therapy for serious infections associated with sepsis and septic shock is contingent only on the risk of death: a meta-analytic / metaregression study. Crit Care Med, 2010, 38(8): 1651-1664.
22. Jalili M, Barzegari H, Pourtabatabaei N, et al. Effect of door-to-antibiotic time on mortality of patients with sepsis in emergency department: a prospective cohort study. Acta Med Iran, 2013, 51(7): 454-460.
23. Ferrer R, Martin-Loeches I, Phillips G, et al. Empiric antibiotic treatment reduces mortality in severe sepsis and septic shock from the first hour: results from a guideline-based performance improvement program. Crit Care Med, 2014, 42(8): 1749-1755.
24. Randolph AG, Mcculloh RJ. Pediatric sepsis: important considerations for diagnosing and managing severe infections in infants, children, and adolescents. Virulence, 2014, 5(1): 179-189.
25. Duszyńska W. Strategies of empiric antibiotic therapy in severe sepsis. Anaesthesiol Intensive Ther, 2012, 44(2): 96-103.
26. Kumar A, Safdar N, Kethireddy S, et al. A survival benefit of combination antibiotic therapy for serious infections associated with sepsis and septic shock is contingent only on the risk of death: a meta-analytic/meta-regression study. Crit Care Med, 2010, 38(8): 1651-1664.
27. Skorup P, Maudsdotter L, Lipcsey M, et al. Beneficial antimicrobial effect of the addition of an aminoglycoside to a β-lactam antibiotic in anE. coli porcine intensive care severe sepsis model. PLoS One, 2014, 9(2): e90441.
28. Paul M1, Lador A, Grozinsky-Glasberg S, et al. Beta lactam antibiotic monotherapyversus beta lactam-aminoglycoside antibiotic combination therapy for sepsis. Cochrane Database Syst Rev. 2014, 7(1): CD003344.
29. Horisberger T, Harbarth S, Nadal D, et al. G-CSF and IL-8 for early diagnosis of sepsis in neonates and critically ill children-safety and cost effectiveness of a new laboratory prediction model: study protocol of a randomized controlled trial [ISRCTN91123847]. Crit Care, 2004, 8(6): R443-R450.
30. Dimopoulos G, Poulakou G, Pneumatikos IA, et al. Short-vs long-duration antibiotic regimens for ventilator-associated pneumonia: a systematic review and meta-analysis. Chest, 2013, 144(6): 1759-1767.
31. Oliveira CF, Botoni FA, Oliveira CR, et al. Procalcitoninversus C-reactive protein for guiding antibiotic therapy in sepsis: a randomized trial. Crit Care Med, 2013, 41(10): 2336-2343.
32. Dellinger RP, Levy MM, Carlet JM, et al. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2008. Intensive Care Med, 2008, 34(1): 17-60.
33. Bouadma L, Luyt CE, Tubach F, et al. Use of procalcitonin to reduce patients’ exposure to antibiotics in intensive care units (PRORATA trial): a multicentre randomised controlled trial. Lancet, 2010, 375(9713): 463-474.
34. Schuetz P, Chiappa V, Briel M, et al. Procalcitonin algorithms for antibiotic therapy decisions: a systematic review of randomized controlled trials and recommendations for clinical algorithms. Arch Intern Med, 2011, 171(15): 1322-1331.
35. 黃彩芝, 莫麗亞, 李先斌, 等. 不同細菌感染所致膿毒癥患兒血清降鈣素原水平的研究. 國際檢驗醫學雜志, 2010, 31(10): 1110-1111.

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