Risk and causes of paediatric hospital-acquired bacteraemia in Kilifi District Hospital, Kenya: a prospective cohort study
Risk and causes of paediatric hospital-acquired bacteraemia in Kilifi District Hospital, Kenya: a prospective cohort study
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DOI：
10.1016/s0140-6736(11)61622-x
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发表时间：
2011-12-10
期刊：
影响因子：
168.9
通讯作者：
Scott, J. Anthony G.
中科院分区：
文献类型：
--
作者：
Aiken, Alexander M.;Mturi, Neema;Scott, J. Anthony G.
背景 在撒哈拉以南非洲地区，社区获得性菌血症是儿童疾病和死亡的重要原因。我们的目的是确定非洲儿童医院获得性（院内）菌血症的程度和原因。方法我们回顾了2002年4月16日至2009年9月30日期间前瞻性收集的肯尼亚基利菲地区医院33 188例入院的监测数据。如果菌血症在入院后48小时或更长时间发生，我们将其定义为院内菌血症。我们评估了院内菌血症的入院风险、每日发生率、对死亡率的影响以及微生物原因，并通过多变量 Cox 回归分析了危险因素。对发病率的影响通过与时间匹配的无菌血症患者进行比较来衡量住院时间的增加。 结果 在此期间，院内菌血症的总体风险为 5.9/1000 名入院者 (95% CI 5.2-6.9)，但我们记录到风险每年增加 27%。住院期间发病率为1.0/1000天（0.87-1.14），比同一地区社区获得性菌血症高出约40倍。医院菌血症患者的死亡率为 53%，而社区获得性菌血症患者的死亡率为 24%，无菌血症患者的死亡率为 6%。在幸存者中，院内菌血症使住院时间延长了 10.1 天 (3.0-17.2)。肺炎克雷伯菌、大肠杆菌、金黄色葡萄球菌、不动杆菌、D 族链球菌和铜绿假单胞菌占医院感染的四分之三。院内菌血症与严重营养不良（风险比 2.52，95% CI 1.79-3.57）和无严重贫血儿童的输血显着相关（4.99; 3.39-7.37）。 解释 我们的研究结果表明，虽然院内菌血症很少见，但它对发病率和死亡率有严重影响，而且其微生物学原因与非严重贫血的微生物学原因不同。 社区获得性菌血症。在低收入国家，院内感染基本上未被认识到或记录为健康风险，但随着人们对其发生的认识的提高以及其他重要儿童疾病的逐步控制，院内感染很可能成为公共卫生优先事项。
Background In sub-Saharan Africa, community-acquired bacteraemia is an important cause of illness and death in children. Our aim was to establish the magnitude and causes of hospital-acquired (nosocomial) bacteraemia in African children.Methods We reviewed prospectively collected surveillance data of 33 188 admissions to Kilifi District Hospital, Kenya, between April 16, 2002, and Sept 30, 2009. We defined bacteraemia as nosocomial if it occurred 48 h or more after admission. We estimated the per-admission risk, daily rate, effect on mortality, and microbial cause of nosocomial bacteraemia and analysed risk factors by multivariable Cox regression. The effect on morbidity was measured as the increase in hospital stay by comparison with time-matched patients without bacteraemia.Findings The overall risk of nosocomial bacteraemia during this period was 5.9/1000 admissions (95% CI 5.2-6.9) but we recorded an underlying rise in risk of 27% per year. The incidence was 1.0/1000 days in hospital (0.87-1.14), which is about 40 times higher than that of community-acquired bacteraemia in the same region. Mortality in patients with nosocomial bacteraemia was 53%, compared with 24% in community-acquired bacteraemia and 6% in patients without bacteraemia. In survivors, nosocomial bacteraemia lengthened hospital stay by 10.1 days (3.0-17.2). Klebsiella pneumoniae, Escherichia coli, Staphylococcus aureus, Acinetobacter spp, group D streptococci, and Pseudomonas aeruginosa accounted for three-quarters of nosocomial infections. Nosocomial bacteraemia was significantly associated with severe mal nutrition (hazard ratio 2.52, 95% CI 1.79-3.57) and blood transfusion in children without severe anaemia (4.99; 3.39-7.37).Interpretation Our findings show that although nosocomial bacteraemia is rare, it has serious effects on morbidity and mortality, and the microbiological causes are distinct from those of community-acquired bacteraemia. Nosocomial infections are largely unrecognised or undocumented as a health risk in low-income countries, but they are likely to become public health priorities as awareness of their occurrence increases and as other prominent childhood diseases are progressively controlled.