Division of Emergency Medicine, Children's Memorial Hospital, Chicago, IL, USA.
Pediatr Infect Dis J. 2011 Feb;30(2):136-40. doi: 10.1097/INF.0b013e3181f385bf.
the purpose of this study was to describe the incidence of serious bacterial infections in febrile outpatient pediatric kidney transplant recipients and to assess the utility of using white blood cell indices to identify patients at low risk for bacteremia.
a retrospective study was conducted on all kidney transplant recipients followed at a single children's hospital. All outpatient visits from January 1, 1995 to June 6, 2007 in which fever was evaluated were reviewed. Patients with history of a primary immunodeficiency, receiving concurrent chemotherapy, or a stem cell or small bowel transplant were excluded. Demographic, historical, physical examination, laboratory, and radiographic data were then recorded.
in all, 101 patients had 251 individual episodes of fever evaluation. In 209 visits, a blood culture was drawn with results available. There were 21 (10.0%) true positive blood cultures and 3 (1.4%) false positives. Two-thirds of the true positive blood cultures occurred in patients with indwelling hardware. There was a positive urine culture in 52/192 (27.1%) visits. Pneumonia was diagnosed in 14/74 (18.9%) visits. In nonill-appearing children without indwelling central lines or focal bacterial infections, the incidence of bacteremia was zero. No practical decision rule based on white blood cell indices could be derived.
the majority of bacteremic cases in febrile outpatient pediatric kidney transplant patients occurred in patients with indwelling hardware. We did not detect any occult cases of bacteremia in this study cohort. A larger prospective multicenter study is required to confirm the low incidence of bacteremia in this patient subset.
本研究旨在描述发热门诊儿科肾移植受者严重细菌感染的发生率，并评估使用白细胞指数识别低菌血症风险患者的效用。
对单家儿童医院随访的所有肾移植受者进行回顾性研究。回顾 1995 年 1 月 1 日至 2007 年 6 月 6 日期间所有因发热而接受评估的门诊就诊。排除有原发性免疫缺陷病史、接受同期化疗或干细胞或小肠移植的患者。然后记录人口统计学、病史、体格检查、实验室和影像学数据。
共有 101 例患者有 251 次发热评估。在 209 次就诊中，抽取了血培养，结果显示有 21 例（10.0%）血培养阳性和 3 例（1.4%）血培养假阳性。三分之二的阳性血培养发生在有留置硬件的患者中。192 次就诊中有 52 次（27.1%）尿培养阳性。74 次就诊中有 14 次（18.9%）诊断为肺炎。在外观正常的无留置中心静脉导管或局灶性细菌感染的儿童中，菌血症的发生率为零。无法从白细胞指数得出实用的决策规则。
发热门诊儿科肾移植受者菌血症病例多数发生在留置硬件的患者中。在本研究队列中，我们未发现任何隐匿性菌血症病例。需要进行更大规模的前瞻性多中心研究以确认该患者亚组菌血症的低发生率。
