Life-threatening infections in children in Europe (the EUCLIDS Project): a prospective cohort study
Life-threatening infections in children in Europe (the EUCLIDS Project): a prospective cohort study
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DOI：
10.1016/s2352-4642(18)30113-5
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发表时间：
2018-06-01
影响因子：
36.4
通讯作者：
Levin, Michael
中科院分区：
文献类型：
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作者：
Martinon-Torres, Federico;Salas, Antonio;Levin, Michael
背景败血症和严重的局灶性感染是住院儿童的一个重大疾病负担。我们的目的是了解疾病的负担和儿童危及生命的细菌infections in European.Methods的欧洲联盟儿童危及生命的传染病研究（EUCLIDS）的结果是一个前瞻性的，多中心的，队列研究在欧洲6个国家。前瞻性招募了2012年7月1日至2015年12月31日期间在英国、奥地利、德国、立陶宛、西班牙和荷兰的98家参与医院住院的1个月至18岁脓毒症（或疑似脓毒症）或重度局灶性感染患者。为了评估疾病负担和结果，我们收集了人口统计学和临床数据，使用安全的基于网络的平台，并获得微生物学数据，使用当地可用的临床诊断programmes.Findings 2844例患者被招募并纳入分析。2841例患者中有1512例（53.2%）为男性，中位年龄为39.1个月（IQR 12.4-93.9）。1229例（43.2%）患者发生脓毒症，1615例（56.8%）发生严重局灶性感染。诊断为脓毒症的患者的中位年龄为27.6个月（IQR 9.0-80.2），而诊断为严重局灶性感染的患者的中位年龄为46.5个月（15.8-100.4; p< 0.0001）。在整个队列的2844例患者中，主要临床症状为肺炎（511例[18.0%]患者）、CNS感染（469例[16.5%]）和皮肤及软组织感染（247例[8.7%]）。在1359例（47.8%）儿童中确定了致病微生物，其中最常见的是脑膜炎奈瑟菌（259例[9.1%]患者），其次是金黄色葡萄球菌（222例[7.8%]），肺炎链球菌（219例[7.7%]）和A组链球菌（162例[5.7%]）。1070例（37.6%）患者需要入住儿科重症监护室。2469例患者的结果数据，57（2.2%）发生死亡：7例严重局灶性感染和50例败血症患者。解释败血症或严重局灶性感染入院的儿童死亡率在欧洲是低的。疾病负担主要发生在5岁以下的儿童中，主要是由于疫苗可预防的脑膜炎球菌和肺炎球菌感染。尽管微生物诊断的临床程序的可用性和应用，致病微生物在大约50%的患者中仍然是未知的。版权所有（C）2018 Elsevier Ltd.保留所有权利。
Background Sepsis and severe focal infections represent a substantial disease burden in children admitted to hospital. We aimed to understand the burden of disease and outcomes in children with life-threatening bacterial infections in Europe.Methods The European Union Childhood Life-threatening Infectious Disease Study (EUCLIDS) was a prospective, multicentre, cohort study done in six countries in Europe. Patients aged 1 month to 18 years with sepsis (or suspected sepsis) or severe focal infections, admitted to 98 participating hospitals in the UK, Austria, Germany, Lithuania, Spain, and the Netherlands were prospectively recruited between July 1, 2012, and Dec 31, 2015. To assess disease burden and outcomes, we collected demographic and clinical data using a secured web-based platform and obtained microbiological data using locally available clinical diagnostic procedures.Findings 2844 patients were recruited and included in the analysis. 1512 (53.2%) of 2841 patients were male and median age was 39.1 months (IQR 12.4-93.9). 1229 (43.2%) patients had sepsis and 1615 (56.8%) had severe focal infections. Patients diagnosed with sepsis had a median age of 27.6 months (IQR 9.0-80.2), whereas those diagnosed with severe focal infections had a median age of 46.5 months (15.8-100.4; p< 0.0001). Of 2844 patients in the entire cohort, the main clinical syndromes were pneumonia (511 [18.0%] patients), CNS infection (469 [16.5%]), and skin and soft tissue infection (247 [8.7%]). The causal microorganism was identified in 1359 (47.8%) children, with the most prevalent ones being Neisseria meningitidis (in 259 [9.1%] patients), followed by Staphylococcus aureus (in 222 [7.8%]), Streptococcus pneumoniae (in 219 [7.7%]), and group A streptococcus (in 162 [5.7%]). 1070 (37.6%) patients required admission to a paediatric intensive care unit. Of 2469 patients with outcome data, 57 (2.2%) deaths occurred: seven were in patients with severe focal infections and 50 in those with sepsis.Interpretation Mortality in children admitted to hospital for sepsis or severe focal infections is low in Europe. The disease burden is mainly in children younger than 5 years and is largely due to vaccine-preventable meningococcal and pneumococcal infections. Despite the availability and application of clinical procedures for microbiological diagnosis, the causative organism remained unidentified in approximately 50% of patients. Copyright (C) 2018 Elsevier Ltd. All rights reserved.