Antibiotic-Resistant Bacteremia in Young Children Hospitalized With Pneumonia in Bangladesh Is Associated With a High Mortality Rate.
Antibiotic-Resistant Bacteremia in Young Children Hospitalized With Pneumonia in Bangladesh Is Associated With a High Mortality Rate.
复制标题
DOI：
10.1093/ofid/ofab260
复制
发表时间：
2021-07
影响因子：
4.2
通讯作者：
Ahmed T
中科院分区：
文献类型：
--
作者：
Chisti MJ;Harris JB;Carroll RW;Shahunja KM;Shahid ASMSB;Moschovis PP;Schenkel SR;Hasibur Rahman ASMM;Shahrin L;Faruk T;Kabir F;Ahmed D;Ahmed T
肺炎是5岁以下儿童败血症和死亡的主要原因。然而，我们对肺炎患儿菌血症的病因了解有限。我们对2014年至2017年期间在孟加拉国国际腹泻病研究中心达卡医院（icddr,b）接受放射学证实的肺炎的一组儿童的菌血症和死亡危险因素进行了特征分析。在研究期间，共有4007名幼儿因肺炎住院。共获得血培养1814例（45%）。其中108例（6%）呈阳性。革兰氏阴性病原体占主导地位，占阳性培养物的83%（77%）。其中包括假单胞菌（N = 22）、大肠杆菌（N = 17）、肠沙门氏菌（N = 14，包括11例伤寒沙门氏菌）和肺炎克雷伯菌（N = 11）。革兰氏阳性病原菌包括肺炎球菌（N = 7）和金黄色葡萄球菌（N = 6）。在icddr，b观察到108株肺炎患儿中有20株对所有常规使用的经验抗生素（氨苄西林、庆大霉素、环丙沙星和头孢曲松）耐药。108例菌血症患儿中有31例（29%）死亡，而1706例无菌血症培养患儿中有124例（7%）死亡（优势比[OR]为5.1；95%可信区间[CI]为3.3-8.1;P < .001）。感染对所有常规使用的经验性抗生素具有耐药性的细菌的儿童与没有菌血症的儿童相比，死亡风险更高（OR, 17.3; 95% CI, 7.0-43.1; P < .001）。孟加拉国达卡肺炎幼儿的耐抗生素革兰氏阴性菌血症与高死亡率有关。抗生素耐药性大流行正在缩短孟加拉国幼儿的寿命，迫切需要预防和治疗这些感染的新方法。在孟加拉国，很大一部分患有肺炎和菌血症的儿童携带有耐抗生素的革兰氏阴性病原体。死亡风险与抗生素耐药性增加有关。这些发现表明了抗生素耐药性大流行的后果。
Pneumonia is a leading cause of sepsis and mortality in children under 5 years. However, our understanding of the causes of bacteremia in children with pneumonia is limited. We characterized risk factors for bacteremia and death in a cohort of children admitted to the Dhaka Hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) between 2014 and 2017 with radiographically confirmed pneumonia. A total of 4007 young children were hospitalized with pneumonia over the study period. A total of 1814 (45%) had blood cultures obtained. Of those, 108 (6%) were positive. Gram-negative pathogens predominated, accounting for 83 (77%) of positive cultures. These included Pseudomonas (N = 22), Escherichia coli (N = 17), Salmonella enterica (N = 14, including 11 Salmonella Typhi), and Klebsiella pneumoniae (N = 11). Gram-positive pathogens included Pneumococcus (N = 7) and Staphylococcus aureus (N = 6). Resistance to all routinely used empiric antibiotics (ampicillin, gentamicin, ciprofloxacin, and ceftriaxone) for children with pneumonia at the icddr,b was observed in 20 of the 108 isolates. Thirty-one of 108 (29%) children with bacteremia died, compared to 124 of 1706 (7%) who underwent culture without bacteremia (odds ratio [OR], 5.1; 95% confidence interval [CI], 3.3–8.1; P < .001). Children infected with bacteria resistant to all routinely used empiric antibiotics were at greater risk of death compared to children without bacteremia (OR, 17.3; 95% CI, 7.0–43.1; P < .001). Antibiotic-resistant Gram-negative bacteremia in young children with pneumonia in Dhaka, Bangladesh was associated with a high mortality rate. The pandemic of antibiotic resistance is shortening the lives of young children in Bangladesh, and new approaches to prevent and treat these infections are desperately needed. A large portion of children with pneumonia and bacteremia in Bangladesh harbored antibiotic-resistant Gram-negative pathogens. The risk of death was associated with increasing antibiotic resistance. The findings are an indication of the consequences of the pandemic of antibiotic resistance.
登录
查看更多内容
影响因子：
168.9
作者：
O'Brien, Katherine L.;Levine, Orin S.;Mitchell, Joanne L.
通讯作者：
Mitchell, Joanne L.
影响因子：
6.4
作者：
Alexandrova, Ludmila;Haque, Farhana;Nelson, Eric J.
通讯作者：
Nelson, Eric J.
DOI：
10.1016/s2214-109x(18)30247-x
发表时间：
2018-07
期刊：
The Lancet. Global health
影响因子：
--
作者：
Wahl B;O'Brien KL;Greenbaum A;Majumder A;Liu L;Chu Y;Lukšić I;Nair H;McAllister DA;Campbell H;Rudan I;Black R;Knoll MD
通讯作者：
Knoll MD
影响因子：
168.9
作者：
Chisti, Mohammod J.;Salam, Mohammed A.;Duke, Trevor
通讯作者：
Duke, Trevor
影响因子：
2.8
作者：
Nahar, Papreen;Unicomb, Leanne;Rousham, Emily K.
通讯作者：
Rousham, Emily K.