Mekala Suresh, Jagadisan Barath, Parija Subhash Chandra, Lakshminarayanan Subitha
Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research, Dhanvantri Nagar, Pondicherry, 605006, India.
Indian J Pediatr. 2015 Mar;82(3):260-6. doi: 10.1007/s12098-014-1497-1. Epub 2014 Jun 20.
To prospectively evaluate infectious complications (IC) in pediatric acute liver failure (PALF) by employing surveillance cultures.
From 2011 to 2013, children with PALF in a tertiary care centre received a standard protocolised management. Prophylactic parenteral antibiotics were used without antifungals. Surveillance cultures of blood, urine, ascites and tracheal aspirates were sent. Biochemical and clinical parameters and outcomes were compared between children with and without IC.
Of the 29 children with PALF admitted during the study period (median age 36 mo, range 12-90 mo), 13.8 % had blood stream infections (BSI) at admission. Organisms were isolated in 8.8 % (12/136) of the blood cultures, 13.7 % (11/80) of the urine cultures, 30.8 % (8/26) of the tracheal aspirates and 7.1 % (1/14) of the ascitic fluid cultures. Gram negative bacteriae (n = 17) were the commonest, followed by fungi (n = 13) and gram positive bacteriae (n = 2). Klebsiella pneumoniae and Candida nonalbicans group were the commonest bacteria and fungi respectively. After admission, fungal BSI and urinary tract infections were diagnosed at a median time of 4 d (range 3-8 d) and 3.5 d (range 3-6 d) respectively. ICs were not associated with other complications and increased mortality but with longer hospital and pediatric intensive care unit (PICU) stay.
In this study BSI was a common finding at admission in PALF. Inspite of prophylactic antibiotics, break through gram negative bacterial and fungal ICs were common. Empirical treatment of IC should include broad spectrum antibiotics. Fungal IC occurred beyond 48 h. Prophylactic antifungals at admission may be considered to decrease their frequency. IC prolongs PICU and hospital stay.
通过采用监测培养法对小儿急性肝衰竭（PALF）的感染性并发症（IC）进行前瞻性评估。
2011年至2013年，一家三级医疗中心的PALF患儿接受了标准化的方案管理。使用了预防性肠外抗生素，但未使用抗真菌药物。送检了血液、尿液、腹水和气管吸出物的监测培养样本。对有IC和无IC的患儿的生化及临床参数和结局进行了比较。
在研究期间收治的29例PALF患儿（中位年龄36个月，范围12 - 90个月）中，13.8%在入院时有血流感染（BSI）。在血培养中8.8%（12/136）分离出微生物，尿培养中13.7%（11/80），气管吸出物中30.8%（8/26），腹水培养中7.1%（1/14）。革兰氏阴性菌（n = 17）最为常见，其次是真菌（n = 13）和革兰氏阳性菌（n = 2）。肺炎克雷伯菌和非白色念珠菌分别是最常见的细菌和真菌。入院后，真菌性BSI和尿路感染的诊断中位时间分别为4天（范围3 - 8天）和3.5天（范围3 - 6天）。IC与其他并发症及死亡率增加无关，但与住院时间和儿科重症监护病房（PICU）住院时间延长有关。
在本研究中，BSI是PALF入院时的常见发现。尽管使用了预防性抗生素，但革兰氏阴性菌和真菌性IC的突破仍很常见。IC的经验性治疗应包括广谱抗生素。真菌性IC在48小时后发生。可考虑入院时使用预防性抗真菌药物以降低其发生率。IC会延长PICU和住院时间。
