新生儿耐碳青霉烯类肠杆菌感染的防治

碳青霉烯类耐药已经逐渐成为中国新生儿重症监护室面临的严峻问题。耐碳青霉烯类肠杆菌(carbapenem-resistant enterobacteriaceae,CRE)通过产生碳青霉烯酶,水解包括碳青霉烯类在内的绝大部分β-内酰胺类抗生素,具有高度的耐药性。碳青霉烯酶根据Amber分类可分为A、B、D三类,不同碳青霉烯酶对特定β-内酰胺类抗生素的水解活性不同。目前,CRE在中国NICU住院新生儿中检出率高、病死率高、具有高度的传播性。CRE在新生儿的治疗非常困难,可选药物极其有限、药代/药效动力学数据匮乏、最佳剂量/用药间隔不确定、缺少联合用药研究等因素均给有效抗菌药物治疗带来巨大挑战。成人和儿童中针对CRE主要的抗菌药物包括碳青霉烯类、头孢他定/阿维巴坦、磷霉素、多黏菌素类、氨曲南等,但在新生儿中的使用鲜有研究。CRE一旦定植和感染,清除和治疗极其困难,因此在新生儿病房严格执行医院感染防控措施和抗菌药物使用管理,减少CRE产生、遏制传播、降低感染率是应对CRE流行的最重要措施。

Prevention and treatment of carbapenem-resistant enterobacteriaceae infection in neonates

Carbapenem-resistance is an emerging problem in Chinese neonatal intensive care units.Carbapenem-resistant enterobacteriaceae(CRE)can hydrolyze almost allβ-lactam antibiotics including carbapenems by producing carbapenemase.There are three groups of carbapenemases,namely Amber A,B and D groups,which have different hydrolytic activities to specificβ-lactam antibiotics.Currently,Chinese NICUs have been facing high colonization and infection rates of CRE,with high fatality rate and rapid transmission.The treatment of neonatal CRE infections is extremely difficult.The limited choice of antibiotics,the lack of pharmacokinetic and pharmacodynamic data and the uncertainty of the optimal dose and interval bring great challenges to the effective therapy of neonatal CRE infections.The main antimicrobial agents for CRE in adults and children include carbapenems,ceftazidime/averbactam,fosfomycin,polymyxin,aztreonam,etc.,but there are few studies in neonates.Once infants are colonized or infected by CRE,decolonization and treatment are very difficult.Therefore,strict implementation of infection control and neonatal antimicrobial stewardship programs to reduce CRE production,transmission and infection,are the most important measures to cope with the prevalence of CRE.