Community-acquired bacteremia among hospitalized children in rural central Africa.
Community-acquired bacteremia among hospitalized children in rural central Africa.
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DOI：
10.1016/s1201-9712(01)90067-0
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发表时间：
2001-01-01
期刊：
影响因子：
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通讯作者：
De Mol, P
中科院分区：
文献类型：
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作者：
Bahwere, P;Levy, J;De Mol, P
目的：描述中部非洲一家乡村医院儿童社区获得性菌血症的流行病学，以确定有用的诊断体征或症状。方法：收集1989年至1990年间在路易斯安那儿童医院住院的所有儿童的血培养。记录感染的临床和生物学体征以及营养状况。结果：在纳入研究的779名儿童中，15.9%的儿童入院时有细菌血症。菌血症发生率以黄疸(20/56，35.7%)和发热(119/487，24.4%)最高。相反，重度营养不良儿童菌血症发生率(13.2%)低于体重发育迟缓或营养良好儿童(19.5%)(P=0.046)。即使在严重营养不良的儿童中，发热也是最有用的诊断标准(敏感性和阴性预测值分别为96.0%和97.8%)(敏感性和阴性预测值分别为96.4%和99.1%)。肠杆菌科细菌，主要是沙门氏菌，引起了73%的菌血症。病原菌对氨苄西林和氯霉素耐药率较高。65例菌血症患儿中只有31例(47.7%)对氨苄西林和庆大霉素联合用药有效。入院时菌血症的存在并不显著增加住院期间的死亡风险(19.4%比13.5%；P=0.088)。年龄小于12个月和黄疸是菌血症儿童死亡的独立危险因素。结论：由多重耐药肠杆菌科引起的社区获得性菌血症是中非住院、营养良好和营养不良儿童的一个重要问题。入院时发烧是一个敏感的诊断迹象，即使在营养不良的儿童中也是如此。
OBJECTIVE: To describe the epidemiology of community-acquired bacteremia in children admitted to a rural hospital in central Africa and to identify useful diagnostic signs or symptoms.METHODS: On admission, a blood culture was obtained from all children admitted to Children's Hospital of Lwiro between 1989 and 1990. Clinical and biologic signs of infection and nutritional status were recorded.RESULTS: Among the 779 children included in the study, 15.9% were bacteremic on admission. The rate of bacteremia was the highest among children with jaundice (20/56; 35.7%) and fever (119/487; 24.4%). In contrast, children with severe malnutrition had a lower rate of bacteremia (13.2%) than weight growth retarded or well-nourished children (19.5%) (P = 0.046). Fever was the most useful diagnostic criteria (sensitivity and negative predictive value of 96.0% and 97.8%, respectively) even in severely malnourished children (sensitivity and negative predictive value of 96.4% and 99.1%, respectively). Enterobacteriacea, mostly Salmonella spp, caused 73% of the bacteremia. There was a high rate of resistance to ampicillin and chloramphenicol among the responsible organisms. Only 31 (47.7%) of 65 bacteremic children responded to the combination of ampicillin and gentamicin. The presence of bacteremia on admission did not significantly increase the risk of morality during hospitalization (19.4% compared with 13.5%; P = 0.088). Age less than 12 months and jaundice were independent risk factors for deaths in bacteremic children.CONCLUSIONS: Community-acquired bacteremia caused by multiresistant Enterobacteriacea is an important problem of hospitalized well-nourished and malnourished children in central Africa. Fever on admission is a sensitive diagnostic sign, even in malnourished children.