摘要
目的评估C-反应蛋白(CRP)作为新生儿细菌感染抗生素治疗唯一停药指标的安全性。方法出生体质量>1500 g的109例新生儿生后72 h检测CRP,根据CRP不同分为Ⅰ组(无感染组):应用抗生素治疗3 d后检测CRP<10 mg/L,排除感染,立即停用抗生素,共34例(31.2%);Ⅱ组(感染组):用抗生素治疗3 d后检测CRP>10 mg/L,提示感染,共75例(66.8%)。再将Ⅱ组分为Ⅱa组:每天检测CRP,一旦降至正常,立即停用抗生素,共38例(34.8%);Ⅱb组:应用抗生素至少7 d,待临床表现消失和CRP<10 mg/L后停药,共37例(33.9%)。以停药后10 d内是否需要再次应用抗生素为依据,分别比较各组应用抗生素的疗程和再次感染的机会。结果Ⅰ组2例(5.8%),Ⅱ组无需再次接受抗生素治疗。CRP<10 mg/L者93.5%(102/104)不必再次应用抗生素。抗生素疗程:Ⅰ组为3 d;Ⅱa组为(4.8±0.8)d;Ⅱb组为(9.3±1.8)d;Ⅰ组与Ⅱa组、Ⅱa组与Ⅱb组间在抗生素应用天数方面存在显著差异(P均<0.01);而再感染发生率无差异(P均>0.05)。结论CRP可安全有效地指导新生儿抗生素治疗疗程,可作为新生儿细菌感染停用抗生素的标准。
Objective To explore the safety of C-reactive protein （CRP）, the single parameter to identify the point when antibiotic treatment can be discontinued in a defined major subgroup of neonates treated for suspected bacterial infection. Methods One hundred and nine newborns who had suspected bacterial infection were enrolled from January 2003 to December 2004 in a prospective study. Serum concentrations of CRP were determined at 24-48 hours after admitted. If serum CRP levels were less than 10mg/L, infants were considered unlikely to be infected, and the antibiotic treatment was stopped using CRP as the single decision criterion in 34/109 （31.2%） newborns （group Ⅰ） ; infants with CRP levels of more than 10 mg/L （75/109 cams） were considered likely to be infected and randomized to 2 study groups. In 75 neonates 38 cases were infected（34.8%） （group Ⅱa） ,CRP was discontinued as soon as CRP returned to less than 10 mg/L. Thirty-seven neonates（33.9%） with likely infection were treated for at lea,st 7 days and until neonates heal（group Ⅱb）. Relapse rates of bacterial infections and the period of antibiotic treatment were compared between 3 groups.Results There were no significant difference in pregernace days, birth weight, and relapse of infection in group Ⅰ ,group Ⅱa andgroup Ⅱ b（all P〉0.05 ）, There was only 2/109 cases （5.8%） need a ,,second course of antibiotics because of likety infection and 102/109 cases （93.5%） need not any moor antibiotics. The mean period of antibiotic treatment in group Ⅰ , group Ⅱ a and group Ⅱb were（ 1.2±0.5） days, （4.8±0.8） days and （9.3±1.8） days, respectively. There were significant differences（ all P〈0.01）. Conclusion ,Serum concentrations of CRP can be a ,safety key parameter for individually guiding the duration of antibiotic treatment in a major subgroup of newborns with suspected bacterial infection.
出处
《实用儿科临床杂志》
CAS
CSCD
北大核心
2005年第8期763-764,共2页
Journal of Applied Clinical Pediatrics
关键词
C-反应蛋白
婴儿
新生
细菌感染
抗生素
C-reactive protein
infant, newborn
bacteria infection
antibiotic
