Three-year survey of bacteremia and fungemia in a pediatric intensive care unit
Three-year survey of bacteremia and fungemia in a pediatric intensive care unit
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DOI：
10.1097/00006454-200104000-00009
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发表时间：
2001-04-01
影响因子：
3.6
通讯作者：
Morris, K
中科院分区：
文献类型：
--
作者：
Gray, J;Gossain, S;Morris, K
背景了解重症监护病房（ICU）患者的血流感染（BSI）模式有助于确定抗生素处方政策和感染控制程序。然而，很少有儿科为基础的研究。在儿科ICU对BSI进行了3年的监测，共发生131例显著的菌血症和真菌血症。BSI的发生率为39.0/1000例入院（10.6/1000床日）。84例（64.1%）发作为ICU获得性，27例（20.6%）为社区获得性。革兰氏阳性菌、革兰氏阴性菌和厌氧菌分别占62.2%、30.8%和1.4%，其中酵母菌占5.6%。脑膜炎奈瑟菌是社区获得性感染中最常见的菌种，葡萄球菌在医院获得性感染中占主导地位。87%的患者有明显的基础疾病，包括60.3%的先天获得性疾病。血管内器械是最常见的感染源，占所有事件的41.2%。BSI患儿的粗死亡率为26.5%，而非BSI患儿的粗死亡率为8.1%。ICU中BSI的模式部分取决于接受治疗的患者类型。然而，一些观察结果是普遍适用的，特别是越来越重要的耐药细菌，往往是低毒力和设备相关的。我们的经验表明，普遍使用广谱经验性抗生素来覆盖这些病原体（这有进一步促进抗生素耐药性的风险）可能不会改善患者的结局。我们的研究为其他儿科ICU评估BSI的发生率和结局提供了依据。
Background. Knowledge of the pattern of blood stream infection (BSI) in patients in intensive care units (ICUs) can help determine antibiotic prescribing policy and infection control procedures. However, there have been few pediatric-based studies.Methods. Surveillance of BSI in a pediatric ICU for 3 years, amounting to 131 episodes of significant bacteremia and fungemia.Results. The incidence of BSI was 39.0 per 1000 admissions (10.6 per 1000 bed days). Eighty-four (64.1%) episodes were ICU-acquired, and 27 (20.6%) were community-acquired. Gram-positive, Gram-negative and anaerobic bacteria accounted for 62.2, 30.8 and 1.4%, respectively, of the 143 microorganisms isolated, 5.6% were yeasts. Neisseria meningitidis was the most common species in community-acquired infections, and staphylococci predominated in hospital acquired episodes. Eighty-seven percent of patients had significant underlying disease, including 60.3% with congenitally acquired conditions. Intravascular devices were the most common source of infection, accounting for 41.2% of all episodes. The crude mortality in children with BSI was 26.5%, compared with 8.1% in those without BSI.Conclusions. The pattern of BSI in ICUs is partly determined by the type of patient treated. However, some observations are generally applicable, notably the increasing importance of antibiotic-resistant bacteria that are often of low virulence and device-associated. Our experience suggests that universal use of broad spectrum empiric antibiotics to cover these pathogens (which risks further promoting antibiotic resistance) may not improve patient outcome. Our study provides a basis for other pediatric ICUs to evaluate their rates and outcomes of BSI.