益生菌的使用与 PICU 中念珠菌血症和念珠菌尿症的流行情况。

Probiotic use and prevalence of candidemia and candiduria in a PICU.

机构信息

1Department of Pediatrics, Advanced Pediatric Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India. 2Department of Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

出版信息

Pediatr Crit Care Med. 2013 Nov;14(9):e409-15. doi: 10.1097/PCC.0b013e31829f5d88.

DOI:10.1097/PCC.0b013e31829f5d88

PMID:23965638

Abstract

OBJECTIVES

To compare the prevalence of candidemia and candiduria before and after the introduction of routine use of probiotics in children who received broad-spectrum antibiotics in a PICU.

DESIGN

Retrospective "before and after" study.

SETTING

A 12-bed PICU of a teaching hospital in India.

PATIENTS

Children 3 months to 12 years old, admitted to the PICU over two 9 months' time periods, who received broad-spectrum antibiotics for more than 48 hours.

INTERVENTIONS

Three hundred forty-four patients enrolled between November 2008 and July 2009 after the introduction of routine use of probiotics served as the "probiotic group"; they had received one sachet twice a day of a probiotic mix (EUGI [Wallace Pharma, Goa, India] containing Lactobacillus acidophillus, Lactobacillus rhamnosum, Bifidobacterium longum, Bifidobacterium bifidum, Saccharomyces boulardii, and Streptococcus thermophilus) for 7 days. Three hundred seventy-six children enrolled between February 2007 and October 2007 served as "controls." Blood was sent for bacterial and fungal cultures if clinically indicated and urine catheter/bag specimen was submitted for bacterial and fungal culture twice a week as per unit's protocol.

MEASUREMENTS AND MAIN RESULTS

Primary outcome was growth of Candida in blood (candidemia), and secondary outcomes were growth of Candida in urine (candiduria), nosocomial bloodstream infections, and urinary tract infections. Data were retrieved from the case records. Candidemia was seen in four of 344 patients (1.2%) in the probiotic group and in 14 of 376 (3.7%) in the control group (relative risk, 0.31; 95% CI, 0.10-0.94; p = 0.03). Candiduria was noted in 37 of 344 patients (10.7%) in the probiotic group and 83 of 376 (22%) in the control group (relative risk, 0.48; 95% CI, 0.34-0.7; p = 0.0001). The prevalence of nosocomial bloodstream infection and urinary tract infection in the probiotic and control groups was 20.3% and 26% (p = 0.07) and 14.2% and 19.1% (p = 0.08), respectively.

CONCLUSIONS

Routine use of a mix of probiotics in patients who receive broad-spectrum antibiotics could be a useful strategy to reduce the prevalence of candidemia and candiduria in the PICU.

摘要

目的

比较在小儿重症监护病房（PICU）中广泛使用抗生素的患儿常规使用益生菌前后的念珠菌血症和念珠菌尿症的发生率。

设计

回顾性“前后”研究。

地点

印度一家教学医院的 12 床 PICU。

患者

3 个月至 12 岁的患儿，在两个 9 个月的时间段内入 PICU，接受超过 48 小时的广谱抗生素治疗。

干预措施

344 例患儿于 2008 年 11 月至 2009 年 7 月在引入常规使用益生菌后入组，作为“益生菌组”；他们每天接受两次益生菌混合物（EUGI[Wallace Pharma，果阿，印度]，含有嗜酸乳杆菌、鼠李糖乳杆菌、长双歧杆菌、双歧双歧杆菌、布拉氏酵母菌和嗜热链球菌）一剂量，共 7 天。376 例患儿于 2007 年 2 月至 2007 年 10 月入组，作为“对照组”。如果临床上需要，血液将进行细菌和真菌培养，如果按照单位方案，每周两次将尿导管/袋标本送检进行细菌和真菌培养。

测量和主要结果

主要结局是血液（念珠菌血症）中念珠菌的生长，次要结局是尿液（念珠菌尿症）、医院获得性血流感染和尿路感染。从病历中检索数据。益生菌组中 4 例（1.2%）患儿发生念珠菌血症，对照组中 14 例（3.7%）患儿发生念珠菌血症（相对风险，0.31；95%CI，0.10-0.94；p = 0.03）。益生菌组中有 37 例（10.7%）患儿出现念珠菌尿症，对照组中有 83 例（22%）患儿出现念珠菌尿症（相对风险，0.48；95%CI，0.34-0.7；p = 0.0001）。益生菌组和对照组的医院获得性血流感染和尿路感染发生率分别为 20.3%和 26%（p = 0.07）和 14.2%和 19.1%（p = 0.08）。