Postmortem blood cultures were taken from 105 neonates dying at Harare Hospital during a 1-year period. The infants were characterized by prematurity (63% < 37 weeks gestation), low birth weight (60% < 2500 g) and low Apgar score at 1 min (43% < 3). More than one-half of the infants died within 48 hours of admission. Positive blood cultures within 10 minutes of death occurred in 44% of infants, and Klebsiella sp. were by far the most common isolates. Positive blood cultures were associated with very low birth weight (< 1500 g), and with babies who survived for > 48 hours. Antibodies to human immunodeficiency virus type 1 were found in 40% of the infants, and a high proportion of these had Klebsiella bacteremia. Nearly all the infants had received antibiotic therapy, usually penicillin and gentamicin. Very few babies who had received a cephalosporin had a positive blood culture, and in vitro tests showed that although many organisms were resistant to penicillin and the aminoglycosides, very few showed resistance to the cephalosporins. Our findings suggest that cephalosporins may be useful in treating severe neonatal sepsis, particularly when there is no response to more standard therapy.

译文

死后血液培养来自于在1年期间在哈拉雷医院死亡的105例新生儿。婴儿的特征是早产(63%<37周妊娠),低出生体重(60%<2500 g)和1分钟时Apgar评分低(43%<3)。入院后48小时内,超过一半的婴儿死亡。死亡10分钟内阳性血培养发生在44%的婴儿和克雷伯菌中。是迄今为止最常见的分离株。积极的血液培养与极低的出生体重(<1500 g)以及存活超过48小时的婴儿有关。在40%的婴儿中发现了针对1型人类免疫缺陷病毒的抗体,其中很大一部分患有克雷伯菌菌血症。几乎所有婴儿都接受了抗生素治疗,通常是青霉素和庆大霉素。接受头孢菌素的婴儿很少,血液培养呈阳性,体外试验显示,尽管许多生物体均对青霉素和氨基糖苷具有抗性,但很少有人对头孢菌素具有抗性。我们的发现表明,头孢菌素可能可用于治疗严重的新生儿败血症,尤其是在对标准疗法无反应的情况下。

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