Epidemiological, clinical, and microbiological characteristics of late-onset sepsis among very low birth weight infants in Israel: A national survey
Epidemiological, clinical, and microbiological characteristics of late-onset sepsis among very low birth weight infants in Israel: A national survey
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DOI：
10.1542/peds.109.1.34
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发表时间：
2002-01-01
期刊：
影响因子：
8
通讯作者：
Reichman, B
中科院分区：
文献类型：
--
作者：
Makhoul, IR;Sujov, P;Reichman, B
Objective.医院感染是极低出生体重儿（VLBW）的一个严重问题。我们研究了极低出生体重婴儿迟发性败血症（LOS）与死亡率和发病率之间的关系。方法。从1995年至1998年在以色列出生的5555名VLBW婴儿的国家队列中，4829名存活至少3天，组成了研究人群。在单变量分析中显示与LOS显著相关的母体、围产期或出生后变量在双变量分析中进行检验（校正胎龄）。P值小于或等于0.1的变量随后通过多元逻辑回归进行检验，以评估每个变量对LOS风险的净效应。1453名婴儿（30%）发生了一次或多次血流证实的LOS。革兰阳性菌和革兰阴性菌分别占55.4%和31.2%，主要为凝固酶阴性葡萄球菌和克雷伯菌。与无LOS的婴儿相比，有LOS的婴儿的死亡率显著较高（16.9%比8.6%）。革兰氏阴性LOS（26.2%）和念珠菌LOS（27.6%）后的死亡率相似，并显著高于革兰氏阳性LOS（8.7%）。LOS的显著独立预测因素为胎龄降低、剖宫产、机械通气、动脉导管未闭、坏死性小肠结肠炎和支气管肺发育不良。30%的以色列VLBW婴儿发生LOS。确定了LOS的6个强独立预测因子。认识和了解LOS的流行病学、临床和微生物学特征仍然是管理这种医院感染的关键。
Objective. Nosocomial infections are a serious problem among very low birth weight (VLBW) infants. We studied the association between late-onset sepsis (LOS) and mortality and morbidity in VLBW infants.Methods. From a national cohort of 5555 VLBW infants born in Israel during 1995 through 1998, 4829 survived at least 3 days and composed the study population. Maternal, perinatal, or postnatal variables that showed a significant association with LOS in a univariate analysis were tested in a bivariate analysis (adjusted for gestational age). Variables with P less than or equal to .1 were then tested by a multiple logistic regression for assessing the net effect of each variable on the risk for LOS.Results. One or more episodes of bloodstream-proven LOS occurred in 1453 infants (30%). Gram-positive and Gram-negative bacteria accounted for 55.4% and 31.2% of microbes, respectively, mainly coagulase-negative Staphylococci and Klebsiella. Compared with those without LOS, infants with LOS had a significantly higher mortality rate (16.9% vs 8.6%). Mortality after Gram-negative LOS (26.2%) and Candida LOS (27.6%) was similar and significantly higher than with Gram-positive LOS (8.7%). Significant independent predictors of LOS were decreasing gestational age, cesarean section, mechanical ventilation, patent ductus arteriosus, necrotizing enterocolitis, and bronchopulmonary dysplasia.Conclusions. LOS occurred in 30% of Israeli VLBW infants. Six strong independent predictors for LOS were identified. Recognition and awareness of the epidemiologic, clinical, and microbiologic characteristics of LOS remain the keystones for management of this nosocomial infection.