Epidemiology of blood culture-proven bacterial sepsis in children in Switzerland: a population-based cohort study
Epidemiology of blood culture-proven bacterial sepsis in children in Switzerland: a population-based cohort study
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瑞士儿童血培养确诊细菌性败血症的流行病学：一项基于人群的队列研究
DOI：
10.1016/s2352-4642(17)30010-x
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发表时间：
2017-10-01
影响因子：
36.4
通讯作者：
Berger, Christoph
中科院分区：
文献类型：
--
作者：
Agyeman, Philipp K. A.;Schlapbach, Luregn J.;Berger, Christoph
背景 脓毒症是全世界儿童死亡的主要原因。我们评估了瑞士儿童经血培养证实的细菌性败血症的人群发病率和结果。方法我们在瑞士的十家儿科医院进行了一项多中心、前瞻性队列研究。我们纳入了经血培养证实患有细菌性败血症的新生儿和 17 岁以下儿童。如果儿童在血培养取样时符合 2005 年儿科共识定义的全身炎症反应综合征标准，则符合资格。发病率的计算方法是将 2012-15 年研究中每年败血症发作的次数除以瑞士年底住院儿科人数。主要结局是脓毒症发病后前 30 天内的院内死亡率。调查结果 2011 年 9 月 1 日至 2015 年 12 月 31 日期间，我们招募了 1096 名儿童参加我们的研究。在 1181 例经血培养证实的细菌性败血症中，379 名既往健康儿童中有 382 例（32%）发生，391 名新生儿中有 402 例（34%）发生，341 名有合并症的儿童中有 397 例（34%）发生。儿童发病率为每 10 万人中 25.1 例（95% CI 23.8-26.4），新生儿为每 10 万人中 146.0 例（133.2-159.6）。 1181 例发作中，中心导管相关血流感染和原发性血流感染占 569 例（48%），1181 例发作中，有 455 例（39%）出现器官功能障碍。大肠杆菌（1181 例中的 242 例 [20%]）、金黄色葡萄球菌（1181 例中的 177 例 [15%]）、凝固酶阴性葡萄球菌（1181 例中的 135 例 [11%]）和肺炎链球菌（1181 例中的 118 例 [10%]）是我们研究中最常见的病原体，占57%的剧集。总体病死率为 7%（1181 次发作中的 82 次；95% CI 5.6-8.6），新生儿的死亡率较高（11%，402 次发作中的 45 次；8.4-14.8；调整后比值比 [OR] 4.41，95% CI 1.75-11.1）和有合并症的儿童（7%，402 次发作中的 27 次）。 397 次发作；4.6-9.9；OR 4.97，1.84-13.4）与之前健康的儿童（3%，382 次发作；1.3-4.9）相比。对于没有器官功能障碍的儿童，病死率为 1%（726 次发作中的 5 次 [95% CI 0.3-1.7]），当存在器官功能障碍时，病死率增至 17%（455 次发作中的 77 次 [13.7-20.8]）（调整后 OR 4.84，95% CI 1.40-16.7）。 解释 经血培养证实的细菌性败血症对儿童的负担健康状况仍然相当可观。我们记录了新生儿、既往健康儿童和患有合并症的儿童之间在主要微生物、严重程度和结果方面的主要差异。尽管对于大多数经血培养证实的细菌性败血症发作，没有观察到器官功能障碍，但器官功能障碍的存在与死亡率密切相关。
Background Sepsis is a leading cause of childhood mortality worldwide. We assessed population-based incidence andoutcomes of blood culture-proven bacterial sepsis in children in Switzerland.Methods We did a multicentre, prospective, cohort study at ten paediatric hospitals in Switzerland. We included neonates and children younger than 17 years with blood culture-proven bacterial sepsis. Children were eligible if they met criteria for systemic inflammatory response syndrome-according to 2005 paediatric consensus definitionat the time of blood culture sampling. Incidence was calculated by dividing the number of annual sepsis episodes in the study for the years 2012-15 by the end-of-year resident paediatric population in Switzerland. The primary outcome was in-hospital mortality in the first 30 days after sepsis onset.Findings Between Sept 1, 2011, and Dec 31, 2015, we enrolled 1096 children to our study. Of 1181 episodes of blood culture-proven bacterial sepsis, 382 (32%) occurred in 379 previously healthy children, 402 (34%) in 391 neonates, and 397 (34%) in 341 children with comorbidities. Incidence was 25.1 cases per 100 000 (95% CI 23.8-26.4) in children and 146.0 cases per 100 000 (133.2-159.6) in neonates. Central line-associated bloodstream infections and primary bloodstream infections accounted for 569 (48%) of 1181 episodes, and organ dysfunction was present in 455 (39%) of 1181 episodes. Escherichia coli (242 of 1181 [20%]), Staphylococcus aureus (177 of 1181 [15%]), coagulase-negative staphylococci (135 of 1181 [11%]), and Streptococcus pneumoniae (118 of 1181 [10%]) were the most prevalent pathogens in our study, accounting for 57% of episodes. The overall case-fatality ratio was 7% (82 of 1181 episodes; 95% CI 5.6-8.6), and it was higher in neonates (11%, 45 of 402 episodes; 8.4-14.8; adjusted odds ratio [OR] 4.41, 95% CI 1.75-11.1) and children with comorbidities (7%, 27 of 397 episodes; 4.6-9.9; OR 4.97, 1.84-13.4) compared with previously healthy children (3%, ten of 382 episodes; 1.3-4.9). The case-fatality ratio was 1% (five of 726 episodes [95% CI 0.3-1.7]) for children without organ dysfunction, which increased to 17% (77 of 455 episodes [13.7-20.8]) when organ dysfunction was present (adjusted OR 4.84, 95% CI 1.40-16.7).Interpretation The burden of blood culture-proven bacterial sepsis on child health remains considerable. We recorded key differences in predominant organisms, severity, and outcome between neonates, previously healthy children, and children with comorbidities. Although for most episodes of blood culture-proven bacterial sepsis, no organ dysfunction was seen, presence of organ dysfunction was strongly associated with mortality.