Piening Brar C, Geffers Christine, Gastmeier Petra, Schwab Frank
Institute for Hygiene and Environmental Medicine, Charité University Medical Center, Berlin, Germany.
PLoS One. 2017 Jun 22;12(6):e0180134. doi: 10.1371/journal.pone.0180134. eCollection 2017.
Mortality in very low birth weight infants following microbiology confirmed primary bloodstream infections varies with the type of causative pathogen. Given evidence from other studies that infections with gram negative bacteria and fungi cause a higher case fatality risk. We tried to confirm this in a nation-wide multi-center trial.
A cohort of 55,465 very low birth weight infants from 242 neonatal departments participating in the German national neonatal infection surveillance system NEO-KISS was used to investigate differences in the case fatality risk of microbiology confirmed primary bloodstream infections according to individual pathogens. Cox proportional hazard regression analyses were performed with the outcomes death and time from microbiology confirmed primary bloodstream infections. The results were adjusted to the recorded risk factors and hospital and department characteristics.
A total of 4 094 very low birth weight infants with microbiology confirmed primary bloodstream infections were included in the analysis. The crude case fatality risk was 5.7%. The Cox proportional hazard regression analysis with adjustment for available risk factors revealed that microbiology confirmed primary bloodstream infections caused by Klebsiella spp. (HR 3.17 CI95 1.69-5.95), Enterobacter spp. (HR 3.42 CI95 1.86-6.27), Escherichia coli (HR 3.32 CI95 1.84-6.00) and Serratia spp. (HR 3.30 CI95 1.44-7.57) were associated with significantly higher case fatality risk compared to Staphylococcus aureus. After adjusting, case fatality risk of Candida albicans causing microbiology confirmed primary bloodstream infections was not higher than that of S. aureus.
In very low birth weight infants, bloodstream infections caused by gram negative pathogens have an increased case fatality risk compared to bloodstream infections caused by gram positive pathogens. This should be considered for prevention and therapy. Further research should address the specific risk factors for case fatality of C. albicans bloodstream infections.
微生物学确诊的极低出生体重儿原发性血流感染的死亡率因致病病原体类型而异。鉴于其他研究表明革兰氏阴性菌和真菌感染会导致更高的病死率。我们试图在一项全国性多中心试验中证实这一点。
来自242个新生儿科室的55465名极低出生体重儿组成队列，参与德国国家新生儿感染监测系统NEO-KISS，以调查根据个体病原体确诊的原发性血流感染的病死率差异。采用Cox比例风险回归分析，以微生物学确诊原发性血流感染后的死亡和时间为结局。结果根据记录的风险因素以及医院和科室特征进行了调整。
共有4094名微生物学确诊原发性血流感染的极低出生体重儿纳入分析。粗病死率为5.7%。对可用风险因素进行调整后的Cox比例风险回归分析显示，与金黄色葡萄球菌相比，由克雷伯菌属（HR 3.17，CI95 1.69 - 5.95）、肠杆菌属（HR 3.42，CI95 1.86 - 6.27）、大肠杆菌（HR 3.32，CI95 1.84 - 6.00）和沙雷菌属（HR 3.30，CI95 1.44 - 7.57）引起的微生物学确诊原发性血流感染与显著更高的病死率相关。调整后，白色念珠菌引起的微生物学确诊原发性血流感染的病死率不高于金黄色葡萄球菌。
在极低出生体重儿中，革兰氏阴性病原体引起的血流感染与革兰氏阳性病原体引起的血流感染相比，病死率增加。在预防和治疗中应考虑这一点。进一步的研究应关注白色念珠菌血流感染病死率的具体风险因素。
