Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
Pediatr Crit Care Med. 2010 Jul;11(4):464-8. doi: 10.1097/PCC.0b013e3181ce708d.
To determine whether red blood cell transfusion is similarly associated with nosocomial infections in pediatric intensive care unit patients and whether reduced lymphocyte numbers is a possible mechanism. In adult studies, red blood cell transfusions are associated with nosocomial infections.
Historical cohort study.
Single-center, mixed medical-surgical, closed pediatric intensive care unit of a tertiary university-affiliated children's hospital.
All patients < or = 18 yrs old admitted to the pediatric intensive care unit during a 6-month period from January 1 to July 3, 2005.
None.
Nosocomial infections (respiratory, urinary tract, and bloodstream infections) were the primary outcome measure and were defined as post transfusion if occurring within 14 days after red blood cell transfusion. Of the 209 subjects enrolled, 32 (15%) acquired nosocomial infections and 45 (22%) received red blood cell transfusions. Patients with versus without nosocomial infections had received red blood cell transfusions significantly more often (odds ratio, 18.0; 95% confidence interval, 7.6-45.9; p < .001). In a dose-dependence analysis, we found that patients receiving > or = 3 red blood cell transfusions had a similar prevalence of nosocomial infections compared with those receiving one to two red blood cell transfusions (61% vs. 44%, p = .365), but greater mortality (22% vs. 0%, p = .04). In a multiple logistic regression analysis controlling for gender, age, pediatric intensive care unit length of stay, presence of an invasive catheter, mechanical ventilation, and surgery, red blood cell transfusion remained independently associated with risk of nosocomial infection (odds ratio, 3.73; 95% confidence interval, 1.19-11.85, p = .023). Transfused subjects had lower absolute lymphocyte counts compared with nontransfused subjects (1605 vs. 2054/microL, p = .041), but similar total white blood cell counts (10.4 vs. 11.4 x 10/microL, p = .52).
Red blood cell transfusion in pediatric intensive care unit patients is associated with an increased risk of nosocomial infections.
确定红细胞输注是否与儿科重症监护病房（PICU）患者的医院获得性感染同样相关，以及淋巴细胞数量减少是否是一种可能的机制。在成人研究中，红细胞输注与医院获得性感染相关。
历史队列研究。
单中心、混合内科-外科、三级大学附属儿童医院封闭式儿科重症监护病房。
2005 年 1 月 1 日至 7 月 3 日期间，入住儿科重症监护病房的所有年龄≤18 岁的患者。
无。
医院获得性感染（呼吸道、泌尿道和血流感染）是主要的观察结果，如果在红细胞输注后 14 天内发生，则定义为输血后感染。在纳入的 209 名患者中，32 名（15%）发生医院获得性感染，45 名（22%）接受了红细胞输注。发生医院获得性感染的患者与未发生医院获得性感染的患者相比，接受红细胞输注的频率明显更高（比值比，18.0；95%置信区间，7.6-45.9；p<0.001）。在剂量依赖性分析中，我们发现，与接受 1-2 次红细胞输注的患者相比，接受>或=3 次红细胞输注的患者的医院获得性感染发生率相似（61%比 44%，p=0.365），但死亡率更高（22%比 0%，p=0.04）。在控制性别、年龄、儿科重症监护病房住院时间、有创导管、机械通气和手术的多变量逻辑回归分析中，红细胞输注仍然与医院获得性感染的风险独立相关（比值比，3.73；95%置信区间，1.19-11.85，p=0.023）。与未输血的患者相比，输血的患者的绝对淋巴细胞计数较低（1605 比 2054/μL，p=0.041），但总白细胞计数相似（10.4 比 11.4×10/μL，p=0.52）。
儿科重症监护病房患者的红细胞输注与医院获得性感染的风险增加有关。
