Maldini Branka, Antolić Stanko, Sakić-Zdravcević Katarina, Karaman-Ilić Maja, Janković Sasa
Department of Anesthesia and Intensive Care Unit, General Hospital "Sveti Duh", Zagreb, Croatia.
Coll Antropol. 2007 Dec;31(4):1083-8.
Bacteremia is a common cause of morbidity and mortality in children treated in pediatric intensive care unit (PICU). We have investigated the causative agents of bacteremia in our PICU over a one-year period, to determine mortality associated with such infection and identify the dependent predictors for morbidity and mortality. From 1 January till 31 December 2006, 479 patients were admitted in the PICU and 379 blood culture samples were taken. Samples were incubated in the BACTEC 9050 System, and isolates identified by routine microbiological methods. A pair of samples taken for aerobic and anaerobic culture were statistically regarded as one sample. Data collected from the medical records of each patient were recorded onto standardized collections sheets and included demographic information, predisposing conditions, source(s) of infection, important clinical and laboratory parameters at the time of infection, and microbiological data. Based on these data, positive blood cultures were classified as either contaminants or true bacteremias. During a year period, 117 episodes of bacteremia were documented in 72 patients. The most frequent isolates were the coagulase-negative staphylococci 32.2% (39), followed by Candida spp. 30.5% (36). The mean white blood cell count (WBC) on the day of bacteremia was 15.2 x 10(9)/L (range 0.1-48.0 x 10(9)/L), and 3.3% of episodes occurred in neutropenic (WBC count < 1 x 10(9)/L) children. The mean temperature on the day of infection was 38.2 +/- 1.1 degrees C (range, 34-41 degrees C). Some newborns 23% (n = 5) had a significantly lower mean temperature (p < 0.02) and lower mean WBC count (p < 0.05) than older children. Hemodynamic instability was noted in 11% of bacteremic episodes. Among all bacteremias, intravascular catheters were implicated in 22.6%, pneumonia in 20.4%, genitourinary tract in 14.2%, surgical wounds in 11.7% and, gastrointestinal tract in 9.8%. Seven patients died because of sepsis. Early diagnosis, prompt blood culture reports, followed by appropriate antibiotic treatment is essential in reducing mortality in such patients. Short hospital stay and restricted use of invasive devices should be the aims to reduce the risk of bacteremia during the stay in the PICU.
菌血症是儿科重症监护病房（PICU）接受治疗的儿童发病和死亡的常见原因。我们对我院PICU一年内菌血症的病原体进行了调查，以确定此类感染相关的死亡率，并确定发病和死亡的相关预测因素。2006年1月1日至12月31日，479例患者入住PICU，共采集379份血培养样本。样本在BACTEC 9050系统中培养，分离株通过常规微生物学方法鉴定。用于需氧和厌氧培养的一对样本在统计学上视为一个样本。从每位患者的病历中收集的数据记录在标准化收集表上，包括人口统计学信息、易感因素、感染源、感染时重要的临床和实验室参数以及微生物学数据。基于这些数据，血培养阳性分为污染菌或真性菌血症。在一年期间，72例患者记录到117次菌血症发作。最常见的分离株是凝固酶阴性葡萄球菌32.2%（39株），其次是念珠菌属30.5%（36株）。菌血症当天的平均白细胞计数（WBC）为15.2×10⁹/L（范围0.1 - 48.0×10⁹/L），3.3%的发作发生在中性粒细胞减少（WBC计数<1×10⁹/L）的儿童中。感染当天的平均体温为38.2±1.1℃（范围34 - 41℃）。一些新生儿23%（n = 5）的平均体温显著较低（p < 0.02），平均WBC计数也较低（p < 0.05）。11%的菌血症发作出现血流动力学不稳定。在所有菌血症中，血管内导管相关的占22.6%，肺炎相关的占20.4%，泌尿生殖道相关的占14.2%，手术伤口相关的占11.7%，胃肠道相关的占9.8%。7例患者因败血症死亡。早期诊断、及时的血培养报告，随后进行适当的抗生素治疗对于降低此类患者的死亡率至关重要。缩短住院时间和限制侵入性设备的使用应作为降低PICU住院期间菌血症风险的目标。
