Changing Epidemiology of Bacteremia in Infants Aged 1 Week to 3 Months
Changing Epidemiology of Bacteremia in Infants Aged 1 Week to 3 Months
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DOI：
10.1542/peds.2011-1546
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发表时间：
2012-03-01
期刊：
影响因子：
8
通讯作者：
Herz, Arnd M.
中科院分区：
文献类型：
--
作者：
Greenhow, Tara L.;Hung, Yun-Yi;Herz, Arnd M.
背景：几十年来，幼儿菌血症一直是一个重要的持续关注问题。尽管产前筛查和婴儿免疫接种发生了变化，但目前这一问题的流行病学很少受到关注。方法：我们对2005年1月1日至2009年12月31日期间在北加州凯撒医疗机构收集的所有足月、1周至3个月大的健康婴儿的血液培养进行了回顾性分析。结果：在研究期间，从160 818名足月婴儿中收集了4255个血培养物。所有血培养中只有2%的病原体阳性（93/4255），而247个阳性培养是由于污染物所致。真菌血症的发生率为0.57 / 1000足月。最常见的病原菌为大肠杆菌（56%）。98%患有大肠杆菌血症的婴儿患有尿路感染。B群链球菌和金黄色葡萄球菌分别是第二和第三常见的病原体。无一例单核增生李斯特菌菌血症和脑膜炎球菌血症，仅有1例肠球菌菌血症。氨苄青霉素耐药病原体占生物体总数的36%。结论：我们的研究表明，菌血症在婴儿中很少发生，只有2.2%的婴儿进行了血液培养。根据在这一大型队列中发现的病原体流行病学，这些数据表明，目前对疑似菌血症的1周至3个月婴儿推荐的推定抗生素覆盖范围发生了变化。儿科2012;129: e590-e596
BACKGROUND: Bacteremia in young infants has remained an important ongoing concern for decades. Despite changes in prenatal screening and infant immunizations, the current epidemiology of this problem has received little attention.METHODS: We conducted a retrospective analysis of all blood cultures collected at Kaiser Permanente Northern California on full-term, previously healthy infants presenting for care between 1 week to 3 months of age for whom a blood culture was drawn from January 1, 2005, through December 31, 2009.RESULTS: During the study period, 4255 blood cultures were collected from 160 818 full-term infants. Only 2% of all blood cultures were positive for pathogens (93/4255), whereas 247 positive cultures were due to contaminants. The incidence rate of true bacteremia was 0.57 in 1000 full-term births. The most common pathogen was Escherichia coli (56%). Ninety-eight percent of infants with E coli bacteremia had a urinary tract infection. Group B Streptococcus and Staphylococcus aureus were the second and third most common pathogens, respectively. There were no cases of Listeria monocytogenes bacteremia or meningococcemia and only 1 case of enterococcal bacteremia. Ampicillin resistant pathogens accounted for 36% of organisms.CONCLUSIONS: Our study indicates bacteremia in young infants occurs infrequently and in only 2.2% of those who had a blood culture drawn. On the basis of the epidemiology of pathogens found in this large cohort, these data suggest a change in currently recommended presumptive antibiotic coverage in 1-week to 3-month-old infants with suspected bacteremia. Pediatrics 2012; 129: e590-e596