The Changing Epidemiology of Serious Bacterial Infections in Young Infants
The Changing Epidemiology of Serious Bacterial Infections in Young Infants
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DOI：
10.1097/inf.0000000000000225
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发表时间：
2014-06-01
影响因子：
3.6
通讯作者：
Pantell, Robert H.
中科院分区：
文献类型：
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作者：
Greenhow, Tara L.;Hung, Yun-Yi;Pantell, Robert H.
背景：数十年来，疑似严重细菌感染的发热婴儿的管理一直是一个挑战。 B 族链球菌产前筛查和婴儿免疫接种变化的影响在基于人群的研究中很少受到关注。方法：本研究利用电子病历分析了从 1 周至 3 个月大的足月婴儿获得的所有血液、尿液和脑脊液培养物，这些婴儿在 7 年的时间内在北加州 Kaiser Permanente 接受护理。结果：研究期间共有 224,553 名足月婴儿出生期间。在 5396 份血培养中，鉴定出 129 名菌血症婴儿（2%）。在 4599 份尿培养中，778 名婴儿 (17%) 记录了 823 次尿路感染 (UTI) 发作。在 1796 份脑脊液培养物中，16 名婴儿患有细菌性脑膜炎（0.9%）。严重细菌感染（菌血症、尿路感染、脑膜炎）和发热性严重细菌感染的发生率分别为3.75和3.1/1000足月儿。大肠杆菌是菌血症 (78)、尿路感染 (719) 和细菌性脑膜炎 (7) 的主要原因。婴儿B族链球菌菌血症23例，其中脑膜炎6例，无李斯特菌感染病例。百分之九的婴儿有多个感染部位； 10%的尿路感染与菌血症相关，52%的菌血症与尿路感染相关。结论：与早期研究相比，现在发现尿路感染的频率显着高于菌血症和脑膜炎，92%的隐匿性感染与尿路感染相关。这些数据强调了尿液分析对于发热婴儿的重要性。
Background: Management of febrile young infants suspected of having serious bacterial infections has been a challenge for decades. The impact of changes in prenatal screening for Group B Streptococcus and of infant immunizations has received little attention in population-based studies.Methods: This study analyzed all cultures of blood, urine and cerebrospinal fluid obtained from full-term infants 1 week to 3 months of age, who presented for care at Kaiser Permanente Northern California during a 7-year period utilizing electronic medical records.Results: A total of 224,553 full-term infants were born during the study period. Of 5396 blood cultures, 129 bacteremic infants were identified (2%). Of 4599 urine cultures, 823 episodes of urinary tract infection (UTI) were documented in 778 infants (17%). Of 1796 CSF cultures, 16 infants had bacterial meningitis (0.9%). The incidence rate of serious bacterial infections (bacteremia, UTI and meningitis) and febrile serious bacterial infections was 3.75 and 3.1/1000 full-term births, respectively. Escherichia coli was the leading cause of bacteremia (78), UTI (719) and bacterial meningitis (7). There were 23 infants with Group B Streptococcus bacteremia including 6 cases of meningitis and no cases of Listeria infection. Nine percentage of infants had multiple sites of infection; 10% of UTIs were associated with bacteremia and 52% of bacteremia was associated with UTI.Conclusions: Compared with earlier studies, UTIs now are found significantly more often than bacteremia and meningitis with 92% of occult infections associated with UTIs. These data emphasize the importance of an urinalysis in febrile infants.