Babay Hanan A, Twum-Danso Kingsley, Kambal Abdelmageed M, Al-Otaibi Fawzia E
Department of Pathology, Microbiology Unit (32), College of Medicine, King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia. hahabib@ ksu.edu.sa
Saudi Med J. 2005 Oct;26(10):1555-61.
Blood stream infection (BSI) is the leading cause of morbidity and mortality in pediatric patients. This study aims to describe the clinical, microbiological characteristics and outcome of BSI in pediatric patients.
We collected the clinical data from all pediatric patients with positive blood cultures. We identified all isolates from these patients from January 2004 to December 2004 at King Khalid University Hospital (KKUH), Riyadh, Saudi Arabia, and determined antimicrobial susceptibilities by MicroScan Walk Away 96 (Dade Behring Inc., West Sacramento, CA95691, USA).
Two hundred and twenty pediatric patients had BSI, of whom 147 (67%) were males and 71 (32.2%) were from intensive care units (ICUs). Two hundred and ten (95.4%) had single blood culture isolate. One hundred and seventy-three (78.6%) of the isolates were Gram positive bacteria and included the following: Staphylococcus epidermidis (55.4%), Staphylococcus aureus (9.5%) of which 14% were methicillin resistant, Streptococcus pneumoniae (S. pneumoniae) (4.5%), 40% of which were resistant to penicillin and Enterococcus faecalis (4%). Gram negative bacteria were 44 (20%) and included Escherichia coli and Klebsiella pneumoniae (K.pneumoniae) (3.6% each). Three isolates (1.3%) were Candida glabrata. None of the Gram positive isolates were vancomycin resistant. Three K.pneumoniae and one Pseudomonas spp. isolates were multiresistant. One hundred and ninety-four (88%) of BSI isolates were hospital acquired. Fever was the most common presentation of pediatric patients (26%) with positive blood culture with no apparent focus of infection. Respiratory tract infections 26 (12%) were the next most common. We seen sepsis in (7.7%) children between 8 days and 6 months of age. Bone and joint infections, cardiac, renal, gastrointestinal diseases, malignancy and surgical cases were other associated clinical diagnoses of BSI in pediatric patients. Patients with immuno- suppressive disorders with BSI had isolates such as Salmonella spp., S. pneumoniae and Pseudomonas spp. Overall mortality was 13 (6%) (p<0.005) and those patients had underlying serious medical conditions with associated risk factors such as prolonged hospital stay, intensive care unit (ICU) admission, indwelling catheterization, mechanical ventilation and prior antimicrobial use.
Bloodstream infection is an important cause of morbidity and mortality in pediatric patients. Risk factors for hospital acquired infection include: prematurity, prolonged hospitalization, ICU admission, indwelling catheterization, mechanical ventilation and prior antimicrobial therapy.
血流感染（BSI）是儿科患者发病和死亡的主要原因。本研究旨在描述儿科患者BSI的临床、微生物学特征及转归。
我们收集了所有血培养阳性的儿科患者的临床资料。我们对2004年1月至2004年12月在沙特阿拉伯利雅得的哈立德国王大学医院（KKUH）的这些患者的所有分离株进行了鉴定，并通过MicroScan Walk Away 96（美国加利福尼亚州西萨克拉门托市达德拜林公司，邮编95691）测定抗菌药物敏感性。
220例儿科患者发生BSI，其中147例（67%）为男性，71例（32.2%）来自重症监护病房（ICU）。210例（95.4%）有单一血培养分离株。173例（78.6%）分离株为革兰氏阳性菌，包括以下几种：表皮葡萄球菌（55.4%）、金黄色葡萄球菌（9.5%），其中14%对甲氧西林耐药、肺炎链球菌（4.5%），其中40%对青霉素耐药以及粪肠球菌（4%）。革兰氏阴性菌有44例（20%），包括大肠埃希菌和肺炎克雷伯菌（各3.6%）。3例分离株（1.3%）为光滑念珠菌。革兰氏阳性分离株均对万古霉素不耐药。3株肺炎克雷伯菌和1株假单胞菌属分离株多重耐药。194例（88%）BSI分离株为医院获得性。发热是血培养阳性且无明显感染灶的儿科患者最常见的表现（26%）。呼吸道感染26例（12%）是其次最常见的。我们在8天至6个月大的儿童中发现7.7%有败血症。骨和关节感染、心脏、肾脏、胃肠道疾病、恶性肿瘤及外科病例是儿科患者BSI的其他相关临床诊断。患有免疫抑制性疾病且发生BSI的患者有沙门菌属、肺炎链球菌和假单胞菌属等分离株。总体死亡率为13例（6%）（p<0.005），这些患者有潜在的严重基础疾病及相关危险因素，如住院时间延长、入住重症监护病房（ICU）、留置导管、机械通气及先前使用过抗菌药物。
血流感染是儿科患者发病和死亡的重要原因。医院获得性感染的危险因素包括：早产、住院时间延长、入住ICU、留置导管、机械通气及先前的抗菌治疗。
