儿童脓毒症抗感染治疗的研究进展_West China Medical Journal

Authors：

高沪 ,  李熙鸿

四川大学华西第二医院急诊科/出生缺陷与相关妇儿疾病教育部重点实验室（成都 610041）;

Corresponding author：

李熙鸿, Email: hilixihong@163.com

Keywords：

儿童; 脓毒症; 抗感染

DOI：

10.7507/1002-0179.201507105

Video：

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脓毒症是由感染导致的全身炎性反应，为儿科常见急危重症，是全球婴幼儿死亡的最主要原因。早期、适当、充分的抗感染治疗可有效阻止疾病进展，提高患儿生存率，但面对抗菌药物滥用、耐药菌增多，流行病学资料缺乏等现象，如何高效合理地开展脓毒症患者的抗感染治疗、提高抢救成功率面临巨大挑战，尤其是针对儿童这类特殊用药群体。该文从脓毒症定义、病原菌分布与耐药性、感染源控制、合理抗感染等多个方面对近年来国内外儿童脓毒症抗感染治疗的研究进展进行简要综述，从而为临床治疗提供决策依据。

Citation： 高沪, 李熙鸿. 儿童脓毒症抗感染治疗的研究进展. West China Medical Journal, 2017, 32(5): 786-789. doi: 10.7507/1002-0179.201507105 Copy

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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.	毕凌云, 赵德安, 韩子明. 儿童严重脓毒症的认识现状. 医学与哲学, 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.
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8.	臧婉, 邓少丽. 新生儿血培养 541 例病原菌分布及药敏试验结果分析. 现代医药卫生, 2014, 30(1): 11-13, 16.
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14.	蔡小慧, 吕星, 卿之驹. 儿童血培养的病原菌分布及耐药性分析. 国际检验医学杂志, 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.	赵静, 熊涛, 唐军, 等. 早发型和晚发型新生儿脓毒症的临床特点. 实用儿科临床杂志, 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.	黄彩芝, 莫丽亚, 李先斌, 等. 不同细菌感染所致脓毒症患儿血清降钙素原水平的研究. 国际检验医学杂志, 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. 毕凌云, 赵德安, 韩子明. 儿童严重脓毒症的认识现状. 医学与哲学, 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. 杨虎. 儿童脓毒症发病机制及诊治进展. 国际儿科学杂志, 2014, 41(2): 138-141.
8. 臧婉, 邓少丽. 新生儿血培养 541 例病原菌分布及药敏试验结果分析. 现代医药卫生, 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. 吴茜, 肖曙芳, 李斌, 等. 2009～2011 年昆明儿童医院小儿败血症病原菌及耐药分析. 中华临床医师杂志: 电子版, 2013, 7(13): 6090-6092.
13. 侯宏, 高岭, 王霞, 等. 2009 至 2011 年南京地区儿童血培养中病原菌的分布及耐药性分析. 检验医学, 2013, 28(11): 1030-1033.
14. 蔡小慧, 吕星, 卿之驹. 儿童血培养的病原菌分布及耐药性分析. 国际检验医学杂志, 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. 赵静, 熊涛, 唐军, 等. 早发型和晚发型新生儿脓毒症的临床特点. 实用儿科临床杂志, 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. 黄彩芝, 莫丽亚, 李先斌, 等. 不同细菌感染所致脓毒症患儿血清降钙素原水平的研究. 国际检验医学杂志, 2010, 31(10): 1110-1111.

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