Burdet Charles, Clermont Olivier, Bonacorsi Stéphane, Laouénan Cédric, Bingen Edouard, Aujard Yannick, Mentré France, Lefort Agnès, Denamur Erick
From the *AP-HP, Hôpital Bichat, Service de Biostatistiques; †IAME, UMR 1137, INSERM, Univ Paris Diderot, Sorbonne Paris Cité; ‡EA 3105, Univ Paris Diderot, Sorbonne Paris Cité; §AP-HP, Hôpital Robert-Debré, Laboratoire de Microbiologie; ¶AP-HP, Hôpital Robert Debré, Service de Néonatologie, Paris; and ‖AP-HP, Hôpital Beaujon, Service de Médecine Interne, Clichy, France.
Pediatr Infect Dis J. 2014 Aug;33(8):872-9. doi: 10.1097/INF.0000000000000309.
Escherichia coli bacteremia is a major cause of severe sepsis in children. Little is known about predictors of severity.
We analyzed 84 children ≤ 18 years of age with E. coli bacteremia from the prospective COLIBAFI study performed during 2005-2007. The severity of bacteremia was defined as occurrence of death or transfer to intensive care unit. Studied characteristics included age, gender, birth weight, history of prematurity, immunodepression, nosocomial infection, portal of entry, phylogenetic group and subgroup belonging, O-type, virulence gene content and antimicrobial susceptibility. We compared bacterial characteristics in urinary- versus digestive-source bacteremia, in children ≤ 3 versus >3 month of age, and in children versus adults. We also searched for risk factors of severity.
Median age was 2.4 months, 57% males. Most frequent portals of entry were urinary (66.2%) and digestive (19.5%) tracts. Most isolates (63.1%) belonged to B2 phylogroup. Strains in children ≤ 3 months of age exhibited more virulence genes, especially neuC and fyuA/irp2, and were less resistant to antibiotics than in children >3 months of age. Comparing community-acquired urinary-source bacteremia between children and adults, we found that bacteremia were less severe in children, whose strains exhibited a specific virulence gene repertoire and had a higher resistance score than in adults. Seventeen children (20.2%) had a severe bacteremia and 8 died. Non-urinary portal of entry and age ≤ 3 months of age were the only risk factors associated with severity.
E. coli strains responsible for bacteremia exhibit specific characteristics according to age of children. However, host characteristics and portal of entry are the main determinants of severity of E. coli bacteremia in children, as observed in adults.
大肠杆菌菌血症是儿童严重脓毒症的主要病因。关于严重程度的预测因素知之甚少。
我们分析了2005年至2007年期间进行的前瞻性COLIBAFI研究中84名年龄≤18岁的大肠杆菌菌血症患儿。菌血症的严重程度定义为死亡或转入重症监护病房。研究的特征包括年龄、性别、出生体重、早产史、免疫抑制、医院感染、感染入口、系统发育组和亚组归属、O型、毒力基因含量和抗菌药敏性。我们比较了泌尿源性与消化源性菌血症、≤3个月与>3个月龄儿童以及儿童与成人之间的细菌特征。我们还寻找了严重程度的危险因素。
中位年龄为2.4个月，57%为男性。最常见的感染入口是泌尿生殖道（66.2%）和消化道（19.5%）。大多数分离株（63.1%）属于B2系统发育组。≤3个月龄儿童的菌株表现出更多的毒力基因，尤其是neuC和fyuA/irp2，并且比>3个月龄儿童的菌株对抗生素的耐药性更低。比较儿童和成人社区获得性泌尿源性菌血症，我们发现儿童的菌血症不太严重，其菌株表现出特定的毒力基因谱，并且耐药性评分高于成人。17名儿童（20.2%）发生了严重菌血症，8人死亡。非泌尿感染入口和年龄≤3个月是与严重程度相关的唯一危险因素。
导致菌血症的大肠杆菌菌株根据儿童年龄表现出特定特征。然而，正如在成人中观察到的那样，宿主特征和感染入口是儿童大肠杆菌菌血症严重程度的主要决定因素。
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