Features of invasive staphylococcal disease in neonates
Features of invasive staphylococcal disease in neonates
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DOI：
10.1542/peds.2004-0043
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发表时间：
2004-10-01
期刊：
影响因子：
8
通讯作者：
Baker, CJ
中科院分区：
文献类型：
--
作者：
Healy, CM;Palazzi, DL;Baker, CJ
客观的。在1980年代中期，新生儿的侵入性葡萄球菌疾病（ISD）的大多数临床描述与当前的标准相差很大，而新生儿的新生儿的临床描述与1980年代中期之前。我们旨在描述新生儿重症监护病房中ISD的婴儿的当代发病率，临床特征和结果。从2000年1月至2002年6月，对有ISD并在德克萨斯州妇女医院的新生儿重症监护病房进行了一项回顾性队列研究。确认ISD被定义为临床败血症和葡萄球菌（SA）（SA）大于或等于1血培养（BC）或不包括尿液或凝结酶阴性的无菌身体部位葡萄球菌（CONS）从大于或等于2 BC或1 BC和1 bc和无菌体位的位置分离出来。可能的ISD被定义为从公元前1 BC或无菌身体部位分离出来的缺点，该部位对3个感染性疾病专家进行了临床和实验室数据审查，表明抗菌治疗是合适的。分析了已确认并组合确认的加和可能的病例。 137名婴儿（平均妊娠年龄[GA]：27.6周[22.4-36.4]；平均出生体重：981 g [350-2995]），总共149集（83个证实[39 sa，44 cons]，66个可能的可能性）（66个可能的可能性）（66个可能性））被审查了。四个（3％）婴儿患有早发感染（2 SA，2缺点）。感染发作时的中位年龄相似（SA 17天； 18天缺点）。血管内导管（IVC）在少数ISD发作的婴儿中（38％SA，43％缺席）。缺点比SA感染更多地与非常低的出生体重有关（= 2个地点。总的来说，SA的焦点并发症（主要是骨和关节）比缺点更大，导致2至3倍SA相关的发病率高2至3倍。直接归因于任何一种生物（5％SA；确认为5％，已确认/可能的缺点3％）。在少数病例中，缺氧和SA相关的发病率是唯一的出现特征。
Objective. Most clinical descriptions of invasive staphylococcal disease (ISD) in neonates date from before the mid-1980s, when neonatal viability and intensive care differed substantially from current standards. We aimed to describe the contemporary incidence, clinical features, and outcome of infants with ISD in a neonatal intensive care unit.Methods. A retrospective cohort study was conducted of infants who had ISD and were in the neonatal intensive care unit of the Woman's Hospital of Texas, Houston, from January 2000 to June 2002. Confirmed ISD was defined as clinical sepsis and Staphylococcus aureus ( SA) isolated from greater than or equal to1 blood culture (BC) or a sterile body site excluding urine or coagulase-negative staphylococci (CoNS) isolated from greater than or equal to2 BC or from 1 BC and a sterile body site. Probable ISD was defined as CoNS isolated from 1 BC or a sterile body site for which clinical and laboratory data review by 3 infectious disease specialists indicated that antimicrobial treatment was appropriate. Confirmed and combined confirmed plus probable cases were analyzed.Results. A total of 149 episodes (83 confirmed [39 SA, 44 CoNS], 66 probable) in 137 infants (mean gestational age [GA]: 27.6 weeks [22.4-36.4]; mean birth weight: 981 g [350-2995]) were reviewed. Four (3%) infants had early-onset infection (2 SA, 2 CoNS). Median age at infection onset was similar (17 days SA; 18 days CoNS). Intravascular catheters (IVC) were in situ in a minority of infants with ISD episodes (38% SA, 43% CoNS). CoNS more than SA infections were associated with very low birth weight (= 2 sites. Overall, SA had more focal complications ( primarily bone and joint) than CoNS, resulting in a 2- to 3-fold higher SA-associated morbidity rate. Mortality directly attributable to either organism was similar (5% SA; 5% confirmed, 3% confirmed/probable CoNS).Conclusion. CoNS ISD occurred in smaller, more premature infants than SA and was IVC associated in a minority of cases. Hypoxia and hypotension were the only presenting features that differentiated CoNS and SA. SA-associated morbidity was substantial, but SA infection carried no greater risk of death ( 5%) than CoNS.