Baranwal Arun K, Singhi Sunit C, Jayashree M
Emergency & Critical Care Division, Advanced Pediatric Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
J Trop Pediatr. 2007 Aug;53(4):252-8. doi: 10.1093/tropej/fmm023. Epub 2007 May 12.
Staphylococcus aureus causes an impressive spectrum of disease in tropics and subtropics. Scanty data are available regarding disseminated staphylococcal disease (DSD) in children, especially on their critical care needs. It is important to recognize and prioritize patients who may benefit most from Pediatric Critical Care. The objective of this article is to review the, critical care needs, management and outcome of patients with DSD and to identify clinical indicators for need of critical care. The study setting is a Pediatric Intensive Care Unit of an urban tertiary care teaching hospital in a developing economy. Fifty-three patients (age, 1 month to 12 years) with DSD, admitted to PICU during June 1994 to June 1999, form the subjects for the study. DSD was defined as involvement of at least two distant organs with presence of Gram-positive cocci in clusters and/or growth of S. aureus from at least one normally sterile body fluid. Data regarding demographic and clinical picture, microbiological profile, indication for PICU admission, monitoring needs, medical and surgical management and outcome was retrieved from the case records. Critical care problems included septic shock (28/53), pericardial effusion (21/53, cardiac tamponade in six), raised intracranial pressure (5 patients) and refractory status epilepticus (1 patient). The majority developed septic shock after first few doses of parenteral antimicrobials. They required an impressive amount of fluid [100 (56) ml/kg] during initial 6 h of resuscitation, and 90% had myocardial dysfunction requiring inotropic support. Tracheal intubation was needed in 18 (34%) and ventilatory support in 17 (32%) patients. About 60% patients had metabolic abnormalities. Soft tissue disease was associated with high risk of septic shock (RR, 1.77; P < 0.05). Presence of both septic shock and need for ventilation was associated with high mortality (RR, 20.5; P < 0.001). Patients with suspected DSD need intensive cardio-respiratory monitoring during initial 48-72 h of therapy; and those who develops shock, respiratory failure, pericardial effusion and necrotizing soft tissue disease should be prioritized for PICU admission.
金黄色葡萄球菌在热带和亚热带地区引发一系列严重疾病。关于儿童播散性葡萄球菌病（DSD）的数据较少，尤其是关于他们的重症监护需求。识别可能从儿科重症监护中获益最大的患者并对其进行优先排序很重要。本文的目的是回顾DSD患者的重症监护需求、管理和结局，并确定需要重症监护的临床指标。研究地点是一个发展中经济体城市三级护理教学医院的儿科重症监护病房。1994年6月至1999年6月期间入住儿科重症监护病房的53例（年龄1个月至12岁）DSD患者构成了研究对象。DSD被定义为至少两个远处器官受累，伴有成簇的革兰氏阳性球菌以及/或者至少一种正常无菌体液中分离出金黄色葡萄球菌。从病例记录中检索了有关人口统计学和临床表现、微生物学特征、儿科重症监护病房入院指征、监测需求、内科和外科治疗及结局的数据。重症监护问题包括感染性休克（28/53）、心包积液（21/53，其中6例发生心脏压塞）、颅内压升高（5例患者）和难治性癫痫持续状态（1例患者）。大多数患者在最初几剂静脉用抗菌药物后发生感染性休克。在复苏的最初6小时内，他们需要大量液体[100（56）ml/kg]，90%的患者有心肌功能障碍需要使用血管活性药物支持。18例（34%）患者需要气管插管，17例（32%）患者需要通气支持。约60%的患者有代谢异常。软组织疾病与感染性休克的高风险相关（相对危险度，1.77；P<0.05）。同时存在感染性休克和需要通气与高死亡率相关（相对危险度，20.5；P<0.001）。疑似DSD的患者在治疗的最初48 - 72小时需要强化心肺监测；而那些发生休克、呼吸衰竭、心包积液和坏死性软组织疾病的患者应优先入住儿科重症监护病房。
