Bloodstream Infections in Hospitalized Children: Epidemiology and Antimicrobial Susceptibilities
Bloodstream Infections in Hospitalized Children: Epidemiology and Antimicrobial Susceptibilities
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DOI：
10.1097/inf.0000000000001057
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发表时间：
2016-05-01
影响因子：
3.6
通讯作者：
Gerber, Jeffrey S.
中科院分区：
文献类型：
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作者：
Larru, Beatriz;Gong, Wu;Gerber, Jeffrey S.
背景：血流感染是导致发病率和死亡率的主要原因。我们对血流感染的流行病学和耐药性模式的大部分了解来自于对住院成人的研究。方法：我们评估了美国一家大型三级保健儿童医院11年间发生的血流感染的流行病学和耐药性。所有阳性血培养均从临床微生物学实验室记录中进行回顾性鉴定。我们排除了同一患者30天内同一细菌的重复阳性培养和多菌感染。结果：在5508例患者中，我们确定了8196例独特的单菌血症。总体而言，46%为社区发病，72%为革兰氏阳性菌，22%为革兰氏阴性菌，5%为念珠菌。最常见的致病菌为凝固酶阴性葡萄球菌。病原菌(粪肠球菌、金黄色葡萄球菌、肺炎克雷伯菌、鲍曼不动杆菌、铜绿假单胞菌、肠杆菌属)占剧集的20%。金黄色葡萄球菌对万古霉素和利奈唑胺均不耐药，耐甲氧西林金黄色葡萄球菌中万古霉素最低抑菌浓度未见增加。临床上对万古霉素耐药的肠球菌、头孢他啶耐药的铜绿假单胞菌和碳青霉烯耐药的肠杆菌科细菌未见明显增加，但耐甲氧西林金黄色葡萄球菌的比例随着时间的推移而增加(P<；0.01)。结论：革兰氏阳性菌和ESKAPE菌是导致住院儿童菌血症的主要原因。尽管与先前住院成人的报告相比，抗菌素耐药性模式是有利的，但需要持续监测的多中心研究来确定在这种情况下出现抗菌素耐药性的趋势。
Background: Bloodstream infection is a major cause of morbidity and mortality. Much of our understanding of the epidemiology and resistance patterns of bloodstream infections comes from studies of hospitalized adults.Methods: We evaluated the epidemiology and antimicrobial resistance of bloodstream infections occurring during an 11-year period in a large, tertiary care children's hospital in the US. All positive blood cultures were identified retrospectively from clinical microbiology laboratory records. We excluded repeat positive cultures with the same organism from the same patient within 30 days and polymicrobial infections.Results: We identified 8196 unique episodes of monomicrobial bacteremia in 5508 patients. Overall, 46% were community onset, 72% were Gram-positive bacteria, 22% Gram-negative bacteria and 5% Candida spp. Coagulase negative Staphylococcus was the most common isolated organism. ESKAPE pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa and Enterobacter spp.) accounted for 20% of episodes. No S. aureus isolate was resistant to vancomycin or linezolid, and no increase in vancomycin minimum inhibitory concentration among methicillin-resistant S. aureus was observed during the study period. Clinically significant increases in vancomycin-resistant Enterococcus, ceftazidime-resistant P. aeruginosa or carbapenem-resistant Enterobacteriaceae were not observed during the study period; however, rates of methicillin-resistant S. aureus increased over time (P < 0.01).Conclusions: Gram-positive and ESKAPE organisms are leading causes of bacteremia in hospitalized children. Although antimicrobial resistance patterns were favorable compared with prior reports of hospitalized adults, multicenter studies with continuous surveillance are needed to identify trends in the emergence of antimicrobial resistance in this setting.