Denniston Sarah, Riordan F Andrew I
Department of Paediatrics, Birmingham Heartlands Hospital, Bordesley Green East, Birmingham B4 5SS, United Kingdom.
J Infect. 2006 Dec;53(6):387-93. doi: 10.1016/j.jinf.2005.11.185. Epub 2006 Feb 14.
Rates of Staphylococcus aureus bacteraemia (SAB) are published performance indicators for hospital-acquired infection. In adults SAB is often associated with central venous catheters (CVC), mortality is high and up to 40% are MRSA. However, there is little data on SAB in neonates and children in the UK.
To describe the presentation, management and outcome of SAB on a neonatal and paediatric unit in a District General Hospital (DGH) over a 10 year period.
Case notes of children<16 years with SAB between May 1993 and April 2003 were studied. SAB which developed >48 h after admission was defined as hospital-acquired. Contamination was probable if the clinical picture was unsupportive of infection, or if repeat culture was negative and no treatment was given.
Neonatal unit: Thirty-three of 40 episodes were reviewed (median gestation 32 weeks, median age 21 days). Three of 33 (9%) were contaminants. All SAB were hospital acquired. Twenty-six of 30 (87%) had non-specific presentation, but 15 developed a focus of infection (skin 12, chest 3). Seventeen (57%) infants had CVCs. Eight (27%) infants had MRSA bacteraemia, seven with CVCs. Three (10%) infants died. Paediatric unit: Sixty-four of 70 episodes were reviewed (median age 2 years). Thirteen of 64 (20%) were contaminants. Ten of 51 (20%) were hospital acquired. Presentations were with skin infection 18, bone/joint infection 13, non-specific 13, respiratory 8. Only two had MRSA, one with CVC. One (2%) child died, from an unrelated cause.
SAB on a paediatric unit shows a very different pattern compared to SAB in adults. The pattern on a neonatal unit is more similar to that in adults. Both children and neonates have a lower mortality and a lower incidence of MRSA, whilst paediatric SAB has a weaker association with CVC. The proportion of SAB which is hospital acquired is low on a paediatric unit, making SAB an unreliable performance indicator. Most SA in blood cultures are not due to contamination. Prospective studies are needed to determine appropriate investigation and treatment.
金黄色葡萄球菌菌血症（SAB）的发生率是医院获得性感染公布的绩效指标。在成人中，SAB通常与中心静脉导管（CVC）相关，死亡率高，且高达40%为耐甲氧西林金黄色葡萄球菌（MRSA）。然而，在英国，关于新生儿和儿童SAB的数据很少。
描述一家地区综合医院（DGH）新生儿和儿科病房10年间SAB的临床表现、管理及转归。
研究1993年5月至2003年4月期间16岁以下患SAB儿童的病历。入院后48小时后发生的SAB被定义为医院获得性。如果临床表现不支持感染，或重复培养阴性且未给予治疗，则可能为污染。
新生儿病房：40例中有33例接受了回顾（中位孕周32周，中位年龄21天）。33例中有3例（9%）为污染物。所有SAB均为医院获得性。30例中有26例（87%）表现不特异，但15例出现感染灶（皮肤12例，胸部3例）。17例（57%）婴儿有中心静脉导管。8例（27%）婴儿发生MRSA菌血症，7例有中心静脉导管。3例（10%）婴儿死亡。儿科病房：70例中有64例接受了回顾（中位年龄2岁）。64例中有13例（20%）为污染物。51例中有10例（20%）为医院获得性。表现为皮肤感染18例、骨/关节感染13例、非特异性表现13例、呼吸道感染8例。仅2例为MRSA，1例有中心静脉导管。1例（2%）儿童因无关原因死亡。
儿科病房的SAB与成人的SAB表现出非常不同的模式。新生儿病房的模式与成人更相似。儿童和新生儿的死亡率和MRSA发生率均较低，而儿科SAB与中心静脉导管的关联较弱。儿科病房医院获得性SAB的比例较低,使得SAB成为一个不可靠的绩效指标。血培养中大多数金黄色葡萄球菌并非污染所致。需要进行前瞻性研究以确定合适的检查和治疗方法。
