Nosocomial pneumonia and tracheitis in a pediatric intensive care unit - A prospective study
Nosocomial pneumonia and tracheitis in a pediatric intensive care unit - A prospective study
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DOI：
10.1164/ajrccm.155.1.9001306
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发表时间：
1997-01-01
影响因子：
24.7
通讯作者：
Nadeau, D
中科院分区：
文献类型：
--
作者：
Fayon, MJ;Tucci, M;Nadeau, D
我们在一所三级护理大学医院的多学科儿科重症监护室（儿科ICU）进行了一项前瞻性研究，以确定儿童细菌性医院获得性肺炎（BNP）和气管炎（BNT）相关的发病率、危险标志物、危险因素和并发症。在56周的时间里，1,114例连续入住儿科ICU的患者被纳入队列; 154例病例被排除在外，大多数（75%）是因为他们在入院时已经有呼吸道感染。最终样本包括960例住院患者（831例患者）。BNP或BNT的诊断是基于亚特兰大疾病控制中心的标准，使用涉及三位专家的共识方法，他们也将并发症归因于BNP和BNT。共诊断出29例BNP和BNT（3.0%; 95% CI：1.1 - 4.1%）（BNP：1.2%，95% CI：0.7 - 1.9%; BNT：1.8%，95% CI：0.8 - 2.6%）。通过多变量分析保留三个因素作为BNP的独立风险因素或标志物（免疫缺陷、免疫抑制和神经肌肉阻滞），两个因素作为BMT的独立风险因素或标志物（头部创伤和呼吸衰竭）。革兰氏阴性菌和金黄色葡萄球菌是最常在气管抽吸物中发现的微生物。抗生素处方通常归因于BNP（75%）和BNT（59%）。死亡，以及多器官系统衰竭，导致BNP在8%的情况下，但从来没有从BNT。在BNT中，重新插管率为24%。院内细菌性呼吸道感染在危重患儿中很少见。但BNP可引起严重的并发症，在危重患儿中应更加重视BNT。
We conducted a prospective study in the multidisciplinary pediatric intensive care unit (pediatric ICU) of a tertiary-care university hospital in order to determine the incidence, risk markers, risk factors, and complications related to bacterial nosocomial pneumonia (BNP) and tracheitis (BNT) in children. A cohort of 1,114 consecutive admissions to the pediatric ICU was enrolled over a 56-wk period; 154 cases were excluded mostly (75%) because they already had a respiratory infection at entry. The final sample included 960 admissions (831 patients). Diagnosis of BNP or BNT was based on Centers for Disease Control of Atlanta criteria using a consensus method involving three experts, who also attributed complications to BNP and BNT. A total of 29 BNP and BNT (3.0%; 95% CI: 1.1 to 4.1%) were diagnosed (BNP: 1.2%, 95% CI: 0.7 to 1.9%; BNT: 1.8%, 95% CI: 0.8 to 2.6%). Three factors were retained by multivariate analysis as independent risk factors or markers for BNP (immunodeficiency, immunosuppression, and neuromuscular blockade), and two for BMT (head trauma and respiratory failure). Cram-negative bacteria and Staphylococcus aureus were the microorganisms most frequently found in the tracheal aspirates. Prescription of antibiotics was commonly attributable to BNP (75%) and BNT (59%). Death, as well as multiple organ system failure, resulted from BNP in 8% of cases, but never from BNT. In BNT, the reintubation rate was 24%. Nosocomial bacterial respiratory infections are rare in critically ill children. However, BNP causes significant complications, and more attention should be focused on BNT in the critically ill child.