Szydlowski Ellen G, Rudolph Jeffrey A, Vitale Melissa A, Zuckerbraun Noel S
Pediatr Emerg Care. 2017 Dec;33(12):e140-e145. doi: 10.1097/PEC.0000000000000812.
Previous small studies have found a high occurrence of bloodstream infections (BSIs) in patients with intestinal failure, and these rates are higher than reported rates in other pediatric populations with central lines. The primary study objective was to describe the occurrence of BSIs in patients with intestinal failure who present to the pediatric emergency department (ED) with fever.
This 5-year retrospective chart review included febrile patients with intestinal failure and central lines who presented to the Children's Hospital of Pittsburgh ED between 2006 and 2011. Each febrile episode was analyzed at the visit level.
During the study, 72 patients with 519 febrile episodes were identified. Central blood cultures were obtained in 93% (480/519) of episodes and 69% (330/480) were positive. Of all BSIs, 38% (124/330) were polymicrobial, 32% (105/330) were a single gram-positive organism, 25% (84/330) were a single gram-negative organism, and 5% (17/330) were a single fungal organism. Of the bacterial pathogens, 48% (223/460) were gram-negative. Overall, 60% were enteric organisms.
Pediatric patients with intestinal failure and central lines have a high occurrence of BSIs with 69% of cultures positive in this study of ED febrile episodes. In contrast to reports in other populations with central lines, BSI occurrence in patients with intestinal failure and fever is higher and larger proportions are gram-negative and enteric organisms. For these patients, we recommend central and peripheral blood cultures, empiric broad spectrum antibiotics targeting gram-negative and enteric organisms, and hospital admission.
既往小型研究发现肠衰竭患者血流感染（BSIs）发生率较高，且这些发生率高于其他置有中心静脉导管的儿科人群所报告的发生率。主要研究目的是描述因发热就诊于儿科急诊科（ED）的肠衰竭患者中BSIs的发生情况。
这项为期5年的回顾性图表审查纳入了2006年至2011年间因发热且有肠衰竭和中心静脉导管而就诊于匹兹堡儿童医院急诊科的患者。每次发热发作均在就诊层面进行分析。
在研究期间，共识别出72例患者有519次发热发作。93%（480/519）的发作进行了中心血培养，其中69%（330/480）为阳性。在所有BSIs中，38%（124/330）为多微生物感染，32%（105/330）为单一革兰氏阳性菌感染，25%（84/330）为单一革兰氏阴性菌感染，5%（17/330）为单一真菌性感染。在细菌病原体中，48%（223/460）为革兰氏阴性菌。总体而言，60%为肠道菌。
在这项针对急诊科发热发作的研究中，有肠衰竭且置有中心静脉导管的儿科患者BSIs发生率较高，血培养阳性率达69%。与其他置有中心静脉导管人群的报告不同，肠衰竭且发热患者的BSIs发生率更高，且革兰氏阴性菌和肠道菌所占比例更大。对于这些患者，我们建议进行中心血和外周血培养，经验性使用针对革兰氏阴性菌和肠道菌的广谱抗生素，并收入院治疗。
