Low Socioeconomic Status Is Associated with Prolonged Times to Assessment and Treatment, Sepsis and Infectious Death in Pediatric Fever in El Salvador
Low Socioeconomic Status Is Associated with Prolonged Times to Assessment and Treatment, Sepsis and Infectious Death in Pediatric Fever in El Salvador
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DOI：
10.1371/journal.pone.0043639
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发表时间：
2012-08-22
期刊：
影响因子：
3.7
通讯作者：
Sung, Lillian
中科院分区：
文献类型：
--
作者：
Gavidia, Ronald;Fuentes, Soad L.;Sung, Lillian
背景：在低收入和中等收入国家，感染仍然是癌症儿童中毒致死的最常见原因。当发烧时迅速给予抗生素可以防止发展为脓毒症和休克，并作为急性淋巴细胞白血病和急性髓系白血病儿童护理质量的重要指标。我们分析了与(1)从发烧到入院/抗生素治疗的较长时间以及(2)败血症和感染相关死亡率的相关因素。方法：这项前瞻性队列研究包括在圣萨尔瓦多本杰明·布鲁姆医院治疗的0-16岁新诊断的急性白血病儿童。我们在确诊后的一个月内和每次新的发烧发作时采访了父母/照顾者。记录从最初发烧到第一次使用抗生素的时间、脓毒症的发生和感染相关的死亡。结果：在251名入选的儿童中，215名患有急性淋巴细胞白血病(85.7%)。在269例门诊发热事件中，从发烧到决定就医的中位时间为10.0小时(四分位数范围[IQR]5.0~20.0)，从决定就医到首次就医的中位时间为1.8小时(IQR 1.0~3.0)。47例(17.5%)患者发生败血症，7例(2.6%)死于感染。母亲文盲与从发热到决定就诊的时间较长(P=0.029)和脓毒症(优势比[OR]3.06，95%可信区间[CI]1.09~8.63；P=0.034)有关。前往医院的时间越长(OR1.36，95%可信区间1.03-1.81；P=0.031)和家庭年收入越高，感染性死亡越多
Background: Infection remains the most common cause of death from toxicity in children with cancer in low-and middle-income countries. Rapid administration of antibiotics when fever develops can prevent progression to sepsis and shock, and serves as an important indicator of the quality of care in children with acute lymphoblastic leukemia and acute myeloid leukemia. We analyzed factors associated with (1) Longer times from fever onset to hospital presentation/antibiotic treatment and (2) Sepsis and infection-related mortality.Method: This prospective cohort study included children aged 0-16 years with newly diagnosed acute leukemia treated at Benjamin Bloom Hospital, San Salvador. We interviewed parents/caregivers within one month of diagnosis and at the onset of each new febrile episode. Times from initial fever to first antibiotic administration and occurrence of sepsis and infection-related mortality were documented.Findings: Of 251 children enrolled, 215 had acute lymphoblastic leukemia (85.7%). Among 269 outpatient febrile episodes, median times from fever to deciding to seek medical care was 10.0 hours (interquartile range [IQR] 5.0-20.0), and from decision to seek care to first hospital visit was 1.8 hours (IQR 1.0-3.0). Forty-seven (17.5%) patients developed sepsis and 7 (2.6%) died of infection. Maternal illiteracy was associated with longer time from fever to decision to seek care (P = 0.029) and sepsis (odds ratio [OR] 3.06, 95% confidence interval [CI] 1.09-8.63; P = 0.034). More infectious deaths occurred in those with longer travel time to hospital (OR 1.36, 95% CI 1.03-1.81; P = 0.031) and in families with an annual household income