Neonatal and paediatric bloodstream infections: Pathogens, antimicrobial resistance patterns and prescribing practice at Khayelitsha District Hospital, Cape Town, South Africa.
Neonatal and paediatric bloodstream infections: Pathogens, antimicrobial resistance patterns and prescribing practice at Khayelitsha District Hospital, Cape Town, South Africa.
复制标题
新生儿和儿科血流感染：南非开普敦 Khayelitsha 地区医院的病原体、抗菌药物耐药性模式和处方实践。
DOI：
10.7196/samj.2017.v108i2.12601
复制
发表时间：
2018
期刊：
影响因子：
--
通讯作者：
A. Dramowski
中科院分区：
文献类型：
--
作者：
H. Crichton;N. O'Connell;H. Rabie;A. Whitelaw;A. Dramowski
背景
南非（SA）地区医院新生儿和儿科社区获得性和医疗保健相关血流感染（BSI）的流行病学研究不足。
目的
对南非开普敦Khayelitsha地区医院3年（2012年3月1日至2015年2月28日）内新生儿和儿科BSI（0 - 13岁）的回顾性审查。
方法
我们使用实验室，医院，患者和处方数据来确定BSI率，血培养产量和污染率，病原体概况，抗菌药物耐药性，患者人口统计学，BSI结果和抗生素处方实践。
结果
7427份血培养标本中，病原菌检出率低（2.1%，156/7427），血培养污染率高（10.5%，782/7427）。儿科和新生儿BSI发生率分别为4.5和1.4/1000患者日。BSI以革兰阳性菌为主（59.3%），常见病原菌为金黄色葡萄球菌（26.8%）和大肠埃希菌（21.6%）。患者年龄中位数为3个月，男性占多数（57.7%），艾滋病毒感染率为12.8%。与BSI相关的粗死亡率为7.1%（11/156），新生儿死亡率高于婴儿和儿童（6/40（15.0%）v. 5/116（4.3%），p=0.03）和革兰氏阴性菌血症患者与革兰氏阳性菌血症患者相比（6/66（9.1%）v. 5/89（5.6%）; p=0.5）。大多数BSI事件是社区获得性的（138/156; 88.5%），肺炎克雷伯菌和大肠埃希菌中的超广谱β-内酰胺酶（ESBL）携带水平较高。大肠埃希菌（5/5（100%）和8/33（24.2%））。30.6%（45/147）的BSI患者抗菌药物管理不当，包括经验性抗生素使用不当（46.7%）、抗生素双重覆盖（33.3%）和广谱抗生素使用不当（17.8%）。
结论
抗生素耐药病原体（特别是产ESBL的肠杆菌科）在社区获得性BSI中很常见。地区医院的儿科临床医生需要不断接受抗生素管理和血培养采样方面的培训。
BACKGROUND
The epidemiology of neonatal and paediatric community-acquired and healthcare-associated bloodstream infections (BSI) at South African (SA) district hospitals is under-researched.
OBJECTIVE
Retrospective review of neonatal and paediatric BSI (0 - 13 years) at Khayelitsha District Hospital, Cape Town, SA, over 3 years (1 March 2012 - 28 February 2015).
METHODS
We used laboratory, hospital, patient and prescription data to determine BSI rates, blood culture yield and contamination rates, pathogen profile, antimicrobial resistance, patient demographics, BSI outcome and antibiotic prescribing practice.
RESULTS
From 7 427 blood cultures submitted, the pathogen yield was low (2.1%, 156/7 427) while blood culture contamination rates were high (10.5%, 782/7 427). Paediatric and neonatal BSI rates were 4.5 and 1.4/1 000 patient days, respectively. Gram-positive BSI predominated (59.3%); Staphylococcus aureus (26.8%) and Escherichia coli (21.6%) were common pathogens. The median patient age was 3 months, with a predominance of males (57.7%) and a 12.8% prevalence of HIV infection. Crude BSI-associated mortality was 7.1% (11/156), the death rate being higher in neonates than in infants and children (6/40 (15.0%) v. 5/116 (4.3%), respectively; p=0.03) and in patients with Gram-negative compared with Gram-positive bacteraemia (6/66 (9.1%) v. 5/89 (5.6%), respectively; p=0.5). Most BSI episodes were community-acquired (138/156; 88.5%), with high levels of extended-spectrum β-lactamase (ESBL) carriage among Klebsiella pneumoniae and E. coli isolates (5/5 (100%) and 8/33 (24.2%), respectively). Antimicrobial management of BSI was inappropriate in 30.6% of cases (45/147), including incorrect empirical antibiotic (46.7%), dual antibiotic cover (33.3%) and inappropriately broad-spectrum antibiotic use (17.8%).
CONCLUSIONS
Antimicrobial-resistant pathogens (notably ESBL-producing Enterobacteriaceae) were common in community-acquired BSI. Paediatric clinicians at district hospitals require ongoing training in antibiotic stewardship and blood culture sampling.
影响因子：
56.3
作者：
Reddy, Elizabeth A.;Shaw, Andrea V.;Crump, John A.
通讯作者：
Crump, John A.