James Hunter Fly, Kelley R Lee, Sandra R Arnold, Bindiya Bagga, Ajay J Talati, Jeremy S Stultz
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引用次数: 0
摘要
本研究的目的是比较在改变机构指南,用氨苄西林取代万古霉素治疗革兰阳性覆盖物后,坏死性小肠结肠炎(NEC)患者的后遗症和急性肾损伤(AKI)发生率。这是一项回顾性、单中心队列分析,研究对象是在耐甲氧西林金黄色葡萄球菌(MRSA)社区流行率较高的外科新生儿重症监护病房就诊的 2016-2020 年 NEC 患者(n = 73)。多变量逻辑回归用于评估相关性。25例(34%)患者至少出现了一次与NEC相关的后遗症。含氨苄西林的治疗方案与任何后遗症类型或 AKI 均无关联。诊断时月经后年龄小于 29 周([OR] 5.8 [1.2-28.8],P = .03;接受血管加压[OR] 3.3 [1.1-10.2],P = .04)与后遗症有独立关联。NEC III 期与 AKI 独立相关,OR 为 10.6 (2-55.6),P = .005。总之,尽管 MRSA 的发病率很高,但在我们医院,含氨苄西林的治疗方案对 NEC 的治疗是有效的。
A Comparison of Sequelae After a Practice Change From Vancomycin to Ampicillin Containing Antibiotic Regimens for Necrotizing Enterocolitis.
The aim of this study was to compare sequelae and acute kidney injury (AKI) occurrence among patients with necrotizing enterocolitis (NEC) after changing institutional guidelines replacing vancomycin with ampicillin for gram-positive coverage. This was a retrospective, single-center cohort analysis of patients from 2016-2020 (n = 73) with NEC at a surgical neonatal intensive care unit with a high community prevalence of methicillin-resistant Staphylococcus aureus (MRSA). Multivariate logistic regression was utilized to assess associations. Twenty-five (34%) patients had at least 1 sequela related to NEC. Ampicillin containing regimens were not associated with any sequelae type or AKI. Postmenstrual age < 29 weeks at diagnosis ([OR] 5.8 [1.2-28.8], P = .03; and receipt of vasopressors [OR] 3.3 [1.1-10.2], P = .04) were independently associated with sequalae. Stage III NEC was independently associated with AKI, OR 10.6 (2-55.6), P = .005. In conclusion, ampicillin-containing regimens are effective for NEC management at our institution despite a high prevalence of MRSA.
期刊介绍:
Clinical Pediatrics (CLP) a peer-reviewed monthly journal, is a must read for the busy pediatrician. CLP contains state-of-the-art, accurate, concise and down-to earth information on practical, everyday child care topics whether they are clinical, scientific, behavioral, educational, or ethical.