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Antimicrobial stewardship and targeted therapies in the changing landscape of maternal sepsis

Journal of Intensive Medicine 2024年第1期4卷 46-61页

作者： Nishel M Shah Esmita Charani Damien Ming fook-choe cheah Mark R Johnson Department of Metabolism Digestion and ReproductionImperial College LondonChelsea and Westminster HospitalLondonUK Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance Imperial College LondonLondonUK Division of Infectious Diseases and HIV Medicine Department of MedicineGroote Schuur HospitalUniversity of Cape TownCape TownSouth Africa Department of Infectious Diseases Imperial College LondonChelsea and Westminster HospitalLondonUK Department of Paediatrics Faculty of MedicineUniversiti Kebangsaan Malaysia Medical CentreKuala LumpurMalaysia

Pregnant and postnatal women are a high-risk population particularly prone to rapid progression to sepsis with significant morbidity and mortality worldwide.Moreover,severe maternal infections can have a serious detrimental impact on neonates with almost 1 million neonatal deaths annually attributed to maternal infection or sepsis.In this review we discuss the susceptibility of pregnant women and their specific physiological and immunological adaptations that contribute to their vulnerability to sepsis,the implications for the neonate,as well as the issues with antimicrobial stewardship and the challenges this poses when attempting to reach a balance between clinical care and urgent treatment.Finally,we review advancements in the development of pregnancy-specific diagnostic and therapeutic approaches and how these can be used to optimize the care of pregnant women and neonates.

关键词： Sepsis Pregnancy Immunology Cardiovascular Personalised medicine Antibiotic stewardship

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Global variation in skin injures and skincare practices in extremely preterm infants

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World Journal of Pediatrics 2023年第2期19卷 139-157页

作者： Pranav Jani Umesh Mishra Julia Buchmayer Rajesh Maheshwari Daphne D’Çruz Karen Walker Duygu Gözen Krista Lowe Audrey Wright James Marceau Mihaela Culcer Archana Priyadarshi Adrienne Kirby James EMoore Ju Lee Oei Vibhuti Shah Umesh Vaidya Abdelmoneim Khashana Sunit Godambe fook choe cheah Wen-Hao Zhou Xiao-Jing Hu Muneerah Satardien Faculty of Medicine and Health The University of SydneySydneyNSWAustralia Department of Neonatology Westmead HospitalWestmeadNSW2145Australia Comprehensive Center for Pediatrics Department of Pediatrics and Adolescent MedicineDivision of NeonatologyPediatric Intensive Care and NeuropediatricsMedical University of ViennaViennaAustria Department of Newborn Care Royal Prince Alfred HospitalCamperdownNSWAustralia Council of International Neonatal Nurses BostonMAUSA The George Institute for Global Health SydneyNSWAustralia Sydney Institute for Women Children and Their FamiliesSydneyNSWAustralia Pediatric Nursing Department Florence Nightingale Faculty of Nursingİstanbul University-CerrahpaşaIstanbulTurkey The National Health and Medical Research Council Clinical Trials Centre University of SydneySydneyNSWAustralia Connecticut Children’s Division of Neonatal-Perinatal Medicine Connecticut Children’s Medical CenterHartfordCTUSA UCONN School of Medicine FarmingtonCTUSA The Royal Hospital for Women RandwickNSWAustralia School of Women’s and Children’s Health University of New South WalesRandwickNSWAustralia Department of Paediatrics and Institute of Health Policy Management and EvaluationMount Sinai HospitalTorontoCanada Department of Pediatrics King Edward Memorial HospitalPuneIndia Pediatrics Suez Canal UniversityIsmailiaEgypt Divisional Director for Clinical Governance Women’sChildren’s and Clinical SupportImperial College Healthcare NHS TrustLondonUK Department of Pediatrics Faculty of MedicineUniversiti KebangsaanBangiMalaysia Hospital Canselor Tuanku Muhriz Jalan Yaacob LatifBandar Tun RazakKuala LumpurMalaysia Department of Neonatology and Vice President Children’s Hospital of Fudan UniversityShanghaiChina Vice Director of Nursing Department Children’s Hospital of Fudan UniversityShanghaiChina Department of Paediatrics and Child Health Tygerberg HospitalCape TownSouth Africa University of Stellenbosch Cape TownSouth Africa

Background Globally,are skincare practices and skin injuries in extremely preterm infants comparable?This study describes skin injuries,variation in skincare practices and investigates any association between them.Methods A web-based survey was conducted between February 2019 and August 2021.Quantifying skin injuries and describing skincare practices in extremely preterm infants were the main outcomes.The association between skin injuries and skincare practices was established using binary multivariable logistic regression adjusted for regions.Results Responses from 848 neonatal intensive care units,representing all geographic regions and income status groups were received.Diaper dermatitis(331/840,39%)and medical adhesive-related skin injuries(319/838,38%)were the most common injuries.Following a local skincare guideline reduced skin injuries[medical adhesive-related injuries:adjusted odds ratios(aOR)=0.63,95%confidence interval(CI)=0.45–0.88;perineal injuries:aOR=0.66,95%CI=0.45–0.96;local skin infections:OR=0.41,95%CI=0.26–0.65;chemical burns:OR=0.46,95%CI=0.26–0.83;thermal burns:OR=0.51,95%CI=0.27–0.96].Performing skin assessments at least every four hours reduced skin injuries(abrasion:aOR=0.48,95%CI=0.33–0.67;pressure:aOR=0.51,95%CI=0.34–0.78;diaper dermatitis:aOR=0.71,95%CI=0.51–0.99;perineal:aOR=0.52,95%CI=0.36–0.75).Regional and resource settings-based variations in skin injuries and skincare practices were observed.Conclusions Skin injuries were common in extremely preterm infants.Consistency in practice and improved surveillance appears to reduce the occurrence of these injuries.Better evidence regarding optimal practices is needed to reduce skin injuries and minimize practice variations.

关键词： Extremely premature infants Injuries Neonatal intensive care unit Skin care Wounds

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