Hsu Jen-Fu, Chu Shih-Ming, Lee Chiang-Wen, Yang Pong-Hong, Lien Reyin, Chiang Ming-Chou, Fu Ren-Huei, Huang Hsuan-Rong, Tsai Ming-Horng
Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
Department of Nursing, Division of Basic Medical Sciences, and Chronic Diseases and Health Promotion Research Center, Chang Gung University of Science and Technology, Chia-Yi, Taiwan; Research Center for Industry of Human Ecology, Chang Gung University of Science and Technology, Taoyuan, Taiwan.
PLoS One. 2015 Apr 15;10(4):e0124567. doi: 10.1371/journal.pone.0124567. eCollection 2015.
An atypical pattern of neonatal sepsis, characterized by persistent positive blood culture despite effective antimicrobial therapy, has been correlated with adverse outcomes. However, previous studies focused only on coagulate-negative staphylococcus infection.
All episodes of persistent bloodstream infection (BSI), defined as 3 or more consecutive positive blood cultures with the same bacterial species, at least two of them 48 hours apart, during a single sepsis episode, were enrolled over an 8-year period in a tertiary level neonatal intensive care unit. These cases were compared with all non-persistent BSI during the same period.
We identified 81 episodes of persistent BSI (8.5% of all neonatal late-onset sepsis) in 74 infants, caused by gram-positive pathogens (n=38, 46.9%), gram-negative pathogens (n=21, 25.9%), fungus (n=20, 24.7%) and polymicrobial bacteremia (n=2, 2.5%). Persistent BSI does not differ from non-persistent BSI in most clinical characteristics and patient demographics, but tends to have a prolonged septic course, longer duration of feeding intolerance and more frequent requirement of blood transfusions. No difference was observed for death attributable to infection (9.8% vs. 6.5%), but neonates with persistent BSI had significantly higher rates of infectious complications (29.6% vs. 9.2%, P < 0.001), death from all causes (21.6% vs. 11.7%, P = 0.025), and duration of hospitalization among survivors [median (interquartile range): 80.0 (52.5-117.5) vs. 64.0 (40.0-96.0) days, P = 0.005] than those without persistent BSI.
Although persistent BSI does not contribute directly to increased mortality, the associated morbidities, infectious complications and prolonged septic courses highlight the importance of aggressive treatment to optimize outcomes.
一种非典型的新生儿败血症模式，其特征是尽管进行了有效的抗菌治疗，但血培养仍持续呈阳性，这与不良预后相关。然而，以往的研究仅关注凝固酶阴性葡萄球菌感染。
在一所三级新生儿重症监护病房，对8年间所有持续性血流感染（BSI）病例进行研究，持续性血流感染定义为在单次败血症发作期间，同一种细菌连续3次或更多次血培养呈阳性，且其中至少两次间隔48小时。将这些病例与同期所有非持续性BSI病例进行比较。
我们共识别出74例婴儿发生的81次持续性BSI（占所有新生儿晚发性败血症的8.5%），病原体包括革兰氏阳性菌（n = 38，46.9%）、革兰氏阴性菌（n = 21，25.9%）、真菌（n = 20，24.7%）和多微生物菌血症（n = 2，2.5%）。持续性BSI与非持续性BSI在大多数临床特征和患者人口统计学方面无差异，但败血症病程往往更长，喂养不耐受持续时间更长，输血需求更频繁。感染所致死亡无差异（9.8%对6.5%），但持续性BSI新生儿的感染并发症发生率显著更高（29.6%对9.2%，P < 0.001），全因死亡率更高（21.6%对11.7%，P = 0.025），幸存者的住院时间[中位数（四分位间距）：80.0（52.5 - 117.5）天对64.0（40.0 - 96.0）天，P = 0.005]也比非持续性BSI新生儿更长。
虽然持续性BSI不会直接导致死亡率增加，但相关的发病率、感染并发症和延长的败血症病程凸显了积极治疗以优化预后的重要性。
