Paediatric Emergency Department, Cruces University Hospital.
Department of Microbiology, Cruces University Hospital, BioCruces Health Research Institute, University of the Basque Country.
Eur J Emerg Med. 2018 Aug;25(4):274-280. doi: 10.1097/MEJ.0000000000000453.
Determination of the characteristics of paediatric invasive bacterial infections (IBI) is essential for early identification of children requiring immediate antibiotic therapy. The main objective is to characterize the emergency presentation of the IBI among children aged younger than 14 years.
A prospective registry-based cohort study including all patients aged younger than 14 years diagnosed with confirmed IBI (culture or genomic detection using the polymerase chain reaction) was carried out in a paediatric emergency department between 2008 and 2015. Severity criteria were as follows: death, sequelae or admission to the ICU.
Of the 223 IBIs reported, 187 (83.9%) corresponded to previously healthy patients (median age=19 months) and 165 (74%) were well appearing. The most common diagnoses were occult bacteraemia [60 (26.9%)] and sepsis [56 (25.1%)]. The most frequent pathogens were Streptococcus pneumoniae [68 (30.5%)] and Neisseria meningitidis [42 (18.8%)]. Four (1.8) patients died (S. pneumoniae, 2) and eight (3.5%) had sequelae (S. pneumoniae, 5). The diagnoses and clinical characteristics of the children varied significantly depending on the isolated pathogen. Duration of fever less than 24 h, symptoms other than fever and not being well-appearing upon arrival to the emergency department were independent risk factors for greater severity (area under the receiver operating characteristics curve=0.805; 95% confidence interval: 0.741-0.868).
IBIs are commonly diagnosed in previously healthy and well-appearing young children. S. pneumoniae was responsible for the majority of deaths or sequelae. Short duration of fever, symptoms other than fever and not being stable on arrival are associated with greater severity.
确定小儿侵袭性细菌感染（IBI）的特征对于早期识别需要立即进行抗生素治疗的儿童至关重要。主要目的是描述 14 岁以下儿童 IBI 的急诊表现。
这是一项前瞻性基于登记的队列研究，纳入了 2008 年至 2015 年期间在儿科急诊部门诊断为确诊 IBI（培养或聚合酶链反应的基因组检测）的所有 14 岁以下患者。严重程度标准为：死亡、后遗症或入住重症监护病房。
报告的 223 例 IBI 中，187 例（83.9%）为既往健康患者（中位年龄=19 个月），165 例（74%）表现良好。最常见的诊断为隐匿性菌血症[60 例（26.9%）]和败血症[56 例（25.1%）]。最常见的病原体为肺炎链球菌[68 例（30.5%）]和脑膜炎奈瑟菌[42 例（18.8%）]。4 例（1.8%）患者死亡（肺炎链球菌 2 例），8 例（3.5%）有后遗症（肺炎链球菌 5 例）。患儿的诊断和临床特征因分离病原体而异。发热持续时间<24 h、发热以外的症状和就诊时表现不佳是严重程度增加的独立危险因素（受试者工作特征曲线下面积=0.805；95%置信区间：0.741-0.868）。
健康且表现良好的幼儿中常见 IBI 诊断。肺炎链球菌是导致大多数死亡或后遗症的主要病原体。发热持续时间短、发热以外的症状和就诊时不稳定与严重程度增加相关。
