Yogaraj Jeya S, Elward Alexis M, Fraser Victoria J
Division of Infectious Diseases, Department of Internal Medicine, Washington University School of Medicine, St Louis, Missouri 63110, USA.
Pediatrics. 2002 Sep;110(3):481-5. doi: 10.1542/peds.110.3.481.
The objective of this study was to determine the rate, risk factors, and outcomes of nosocomial primary bloodstream infection in pediatric intensive care unit (PICU) patients.
Prospective cohort study.
This study was performed at St Louis Children's Hospital, a 235-bed academic tertiary care center with a combined 22-bed medical and surgical PICU.
Subjects for this study were patients admitted to the PICU between September 1, 1999, and May 31, 2000.
None.
Patients were monitored for the development of nosocomial bloodstream infections from the day of PICU admission until 48 hours after PICU discharge.
Of 911 patients, 526 (58%) were male and 674 (74%) were white. Congenital heart disease (29%), lung disease (25%), and genetic syndrome (18%) were common. There were 65 episodes of primary bloodstream infection in 57 patients; 5 were polymicrobial and 7 patients had multiple bloodstream infections. Coagulase-negative Staphylococcus was the leading cause of bloodstream infection (n = 28), followed by Enterobacter cloacae (n = 8). The rate of bloodstream infection was 13.8 per 1000 central venous catheter days. In multiple logistic regression analysis, patients with bloodstream infection were more likely to have multiple central venous catheters (adjusted odds ratio [aOR]: 5.7; 95% confidence interval [CI]: 2.9-10.9), arterial catheters (aOR: 5.5; 95% CI: 1.8-16.3), invasive procedures performed in the PICU (aOR: 4.0; 95%CI: 2.0-7.8), and be transported out of the PICU (aOR: 3.4; 95% CI: 1.8-6.7) to the radiology or operating room suites. Severity of illness as measured by admission Pediatric Risk of Mortality score, underlying illnesses, and medications were not associated with increased risk of nosocomial bloodstream infection. Conclusions This study identified a high rate of bloodstream infection among St Louis Children's Hospital PICU patients. Risk factors for bloodstream infection were related more to process of care than to severity of illness. Additional research is needed to develop interventions to reduce nosocomial bloodstream infections in children.
本研究的目的是确定儿科重症监护病房（PICU）患者医院获得性原发性血流感染的发生率、危险因素及结局。
前瞻性队列研究。
本研究在圣路易斯儿童医院进行，这是一家拥有235张床位的学术性三级医疗中心，其综合医疗和外科PICU共有22张床位。
本研究的受试者为1999年9月1日至2000年5月31日期间入住PICU的患者。
无。
从患者入住PICU之日起至PICU出院后48小时，对患者进行医院获得性血流感染发生情况的监测。
911例患者中，526例（58%）为男性，674例（74%）为白人。先天性心脏病（29%）、肺部疾病（25%）和遗传综合征（18%）较为常见。57例患者发生了65次原发性血流感染；5次为多微生物感染，7例患者发生了多次血流感染。凝固酶阴性葡萄球菌是血流感染的主要原因（n = 28），其次是阴沟肠杆菌（n = 8）。血流感染发生率为每1000个中心静脉导管日13.8次。在多因素logistic回归分析中，发生血流感染的患者更有可能有多根中心静脉导管（校正优势比[aOR]：5.7；95%置信区间[CI]：2.9 - 10.9）、动脉导管（aOR：5.5；95%CI：1.8 - 16.3），在PICU进行侵入性操作（aOR：：4.0；95%CI：2.0 - 7.8），以及被转运出PICU（aOR：3.4；95%CI：1.8 - 6.7）到放射科或手术室。入院时用儿科死亡风险评分衡量的疾病严重程度、基础疾病和用药情况与医院获得性血流感染风险增加无关。结论本研究发现圣路易斯儿童医院PICU患者中血流感染发生率较高。血流感染的危险因素更多地与护理过程有关，而非疾病严重程度。需要进一步研究以制定减少儿童医院获得性血流感染的干预措施。
