Downes Kevin J, Metlay Joshua P, Bell Louis M, McGowan Karin L, Elliott Michael R, Shah Samir S
Divisions of Infectious Diseases, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, USA.
Clin Infect Dis. 2008 Feb 1;46(3):387-94. doi: 10.1086/525265.
Bloodstream infections (BSIs) are an ever-present concern for clinicians evaluating ill-appearing pediatric patients with central venous catheters (CVCs) in the ambulatory care setting.
We performed a case-control study of a cohort of 200 pediatric patients who were evaluated in the ambulatory care setting and who were found to have laboratory-confirmed BSI in the context of a CVC. This study sought to compare patients with polymicrobial versus monomicrobial BSIs to identify potential risk factors for polymicrobial BSI.
Of the 200 patients enrolled in the study, 73 (37%) had a polymicrobial BSI. Patients with polymicrobial BSI were more likely than those with monomicrobial BSI to be younger (P=.002) and less likely to have been recently discharged from the hospital (P=.01). The odds of a polymicrobial BSI were >4 times greater for patients aged <3 years than for those aged >or=3 years (odds ratio, 4.54; 95% confidence interval, 1.68-12.29), and the odds were 50% lower for those discharged from the hospital in the prior 7 days than for those without recent hospitalization (odds ratio, 0.46; 95% confidence interval, 0.22-0.95) after controlling for an underlying cancer diagnosis and the time of year during which a patient presented. Recent antibiotic use, recent BSI, duration that the CVC had been in place, and underlying gastrointestinal dysfunction were not associated with a risk of polymicrobial BSI.
Younger children and those who had not recently been discharged from the hospital had an increased risk of developing catheter-related polymicrobial BSI. Special consideration should be given to the increased likelihood of polymicrobial BSIs in these pediatric patients when initiating empirical antimicrobial therapy.
血流感染（BSIs）一直是临床医生在门诊环境中评估患有中心静脉导管（CVCs）且病情不佳的儿科患者时所关注的问题。
我们对一组200名在门诊环境中接受评估且经实验室确诊在CVC情况下发生BSI的儿科患者进行了病例对照研究。本研究旨在比较多微生物性BSI患者与单微生物性BSI患者，以确定多微生物性BSI的潜在危险因素。
在纳入研究的200名患者中，73名（37%）患有多微生物性BSI。与单微生物性BSI患者相比，多微生物性BSI患者年龄更小（P = 0.002），且近期出院的可能性更小（P = 0.01）。年龄<3岁的患者发生多微生物性BSI的几率比年龄≥3岁的患者高4倍以上（优势比，4.54；95%置信区间，1.68 - 12.29），在控制潜在癌症诊断和患者就诊时间后，前7天出院的患者发生多微生物性BSI的几率比未近期住院的患者低50%（优势比，0.46；95%置信区间，0.22 - 0.95）。近期使用抗生素、近期发生BSI、CVC留置时间、潜在胃肠功能障碍与多微生物性BSI风险无关。
年龄较小的儿童以及近期未出院的儿童发生导管相关多微生物性BSI的风险增加。在开始经验性抗菌治疗时，应特别考虑这些儿科患者发生多微生物性BSI的可能性增加。
