Department of Pediatrics, University of Rochester Medical Center, 601 Elmwood Ave, Box 667, Rochester, NY 14620.
Pediatrics. 2013 Dec;132(6):990-6. doi: 10.1542/peds.2013-1759. Epub 2013 Nov 11.
Fever in infants is a common clinical dilemma. The objective of this study was to present data from hospital systems across the northeast, southeast, mid-west, and western United States to identify the pathogens causing bacteremia in febrile infants admitted to general care units.
This was a retrospective review of positive blood culture results in febrile infants aged ≤90 days admitted to a general care unit across 6 hospital systems. Data were collected from January 1, 2006 through December 31, 2012 from emergency departments and general inpatient units. Cultures from ICUs, central lines, or infants who had complex comorbidities were excluded, as were repeat cultures positive for the same bacteria. Common contaminants were considered pathogens if they were treated as such.
We identified 181 cases of bacteremia in 177 infants. The most common pathogen was Escherichia coli (42%), followed by group B Streptococcus (23%). Streptococcus pneumoniae was more likely in older infants (P = .01). Non-low-risk bacteremic infants were more likely to have E. coli or group B Streptococcus than low-risk bacteremic infants. We identified no cases of Listeria monocytogenes. Variation between sites was minimal.
This is the largest and most geographically diverse study to date examining the epidemiology of bacteremia in infants. We suggest E. coli is the most common cause of bacteremia in previously healthy febrile infants admitted to a general inpatient unit. We identified no cases of L monocytogenes and question whether empirical therapy remains necessary for this pathogen.
婴儿发热是一种常见的临床难题。本研究旨在展示美国东北部、东南部、中西部和西部的医院系统的数据，以确定导致普通病房收治的发热婴儿菌血症的病原体。
这是对 6 家医院系统普通病房收治的≤90 天发热婴儿血培养阳性结果的回顾性分析。数据收集时间为 2006 年 1 月 1 日至 2012 年 12 月 31 日，来自急诊科和普通住院病房。排除 ICU、中心静脉导管或合并复杂合并症的婴儿的培养物，以及同一细菌重复培养阳性的培养物。常见污染物被认为是病原体，如果它们被作为病原体进行治疗。
我们在 177 名婴儿中确定了 181 例菌血症。最常见的病原体是大肠杆菌（42%），其次是 B 组链球菌（23%）。年龄较大的婴儿更可能患有肺炎链球菌（P=0.01）。非低危菌血症婴儿比低危菌血症婴儿更可能感染大肠杆菌或 B 组链球菌。我们没有发现李斯特菌的病例。各地点之间的差异很小。
这是迄今为止最大和地理分布最广泛的研究，研究了普通病房收治的发热婴儿菌血症的流行病学。我们建议大肠杆菌是普通住院病房收治的既往健康发热婴儿菌血症最常见的原因。我们没有发现李斯特菌的病例，并质疑是否仍然需要对该病原体进行经验性治疗。
