Santiago Maria J, López-Herce Jesús, Vierge Eva, Castillo Ana, Bustinza Amaya, Bellón Jose M, Sánchez Amelia, Fernández Sarah
Pediatric Intensive Care Department, Health Research Institute, Gregorio Marañón General University Hospital of Madrid, School of Medicine, Complutense University of Madrid, Madrid - Spain.
Department of Statistics, Health Research Institute, Gregorio Marañón General University Hospital of Madrid, School of Medicine, Complutense University of Madrid, Madrid - Spain.
Int J Artif Organs. 2017 May 29;40(5):224-229. doi: 10.5301/ijao.5000587. Epub 2017 May 18.
Continuous renal replacement therapies (CRRT) are frequently used in critically ill children and may increase the risk of infection. However, the incidence, characteristics and prognosis of infection in critically ill children on CRRT have not been studied.
Data from a prospective, single-center register of critically ill children treated with CRRT was analyzed.
55 children (40% under 1 year of age) were treated with CRRT between June 2008 and January 2012; 43 patients (78.2%) presented 1 or more infections. The most common condition of patients requiring CRRT was heart disease (69%). Infection occurred a median of 11 days after the initiation of CRRT (IQ range: 4 to 21 days). A total of 21 patients (48.8 %) developed 1 infection, 7 (16.2%) developed 2 infections and 15 (34.9%) developed 3 or more infections. The most frequent infection was catheter-related bacteremia, with no differences in catheter location. CRRT duration longer than 4.5 days was the only risk factor for infection. Patients with infection had a longer length of stay (LOS) in the Pediatric Intensive Care Unit (PICU) than patients without it (37.8 vs. 17.6, p = 0.019), but there were no differences in mortality (30.2% vs. 33.3%; p = 0.84).
Infection rate is high in critically ill children treated with CRRT. More than 4 days of CRRT increases the risk of infection. Infection in these patients entails a longer stay in the PICU but did not increase mortality.
连续性肾脏替代疗法（CRRT）常用于危重症儿童，可能会增加感染风险。然而，接受CRRT治疗的危重症儿童感染的发生率、特征及预后尚未得到研究。
分析了来自一个前瞻性、单中心的接受CRRT治疗的危重症儿童登记数据。
2008年6月至2012年1月期间，55名儿童（40%年龄小于1岁）接受了CRRT治疗；43名患者（78.2%）出现了1次或更多次感染。需要CRRT治疗的患者最常见的疾病是心脏病（69%）。感染发生在CRRT开始后的中位数为11天（四分位间距：4至21天）。共有21名患者（48.8%）发生1次感染，7名（16.2%）发生2次感染，15名（34.9%）发生3次或更多次感染。最常见的感染是导管相关菌血症，导管位置无差异。CRRT持续时间超过4.5天是感染的唯一危险因素。感染患者在儿科重症监护病房（PICU）的住院时间比未感染患者长（37.8天对17.6天，p = 0.019），但死亡率无差异（30.2%对33.3%；p = 0.84）。
接受CRRT治疗的危重症儿童感染率很高。CRRT超过4天会增加感染风险。这些患者的感染导致在PICU的住院时间延长，但并未增加死亡率。
