Crichton H, O'Connell N, Rabie H, Whitelaw A C, Dramowski A
Department of Paediatrics, Khayelitsha District Hospital, Cape Town, South Africa.
S Afr Med J. 2018 Feb 1;108(2):99-104. doi: 10.7196/SAMJ.2017.v108i2.12601.
The epidemiology of neonatal and paediatric community-acquired and healthcare-associated bloodstream infections (BSI) at South African (SA) district hospitals is under-researched.
Retrospective review of neonatal and paediatric BSI (0 - 13 years) at Khayelitsha District Hospital, Cape Town, SA, over 3 years (1 March 2012 - 28 February 2015).
We used laboratory, hospital, patient and prescription data to determine BSI rates, blood culture yield and contamination rates, pathogen profile, antimicrobial resistance, patient demographics, BSI outcome and antibiotic prescribing practice.
From 7 427 blood cultures submitted, the pathogen yield was low (2.1%, 156/7 427) while blood culture contamination rates were high (10.5%, 782/7 427). Paediatric and neonatal BSI rates were 4.5 and 1.4/1 000 patient days, respectively. Gram-positive BSI predominated (59.3%); Staphylococcus aureus (26.8%) and Escherichia coli (21.6%) were common pathogens. The median patient age was 3 months, with a predominance of males (57.7%) and a 12.8% prevalence of HIV infection. Crude BSI-associated mortality was 7.1% (11/156), the death rate being higher in neonates than in infants and children (6/40 (15.0%) v. 5/116 (4.3%), respectively; p=0.03) and in patients with Gram-negative compared with Gram-positive bacteraemia (6/66 (9.1%) v. 5/89 (5.6%), respectively; p=0.5). Most BSI episodes were community-acquired (138/156; 88.5%), with high levels of extended-spectrum β-lactamase (ESBL) carriage among Klebsiella pneumoniae and E. coli isolates (5/5 (100%) and 8/33 (24.2%), respectively). Antimicrobial management of BSI was inappropriate in 30.6% of cases (45/147), including incorrect empirical antibiotic (46.7%), dual antibiotic cover (33.3%) and inappropriately broad-spectrum antibiotic use (17.8%).
Antimicrobial-resistant pathogens (notably ESBL-producing Enterobacteriaceae) were common in community-acquired BSI. Paediatric clinicians at district hospitals require ongoing training in antibiotic stewardship and blood culture sampling.
南非地区医院新生儿及儿童社区获得性和医疗保健相关血流感染（BSI）的流行病学研究不足。
回顾性分析南非开普敦Khayelitsha地区医院3年（2012年3月1日至2015年2月28日）内新生儿及儿童（0 - 13岁）的BSI情况。
我们利用实验室、医院、患者及处方数据来确定BSI发生率、血培养阳性率及污染率、病原体谱、抗菌药物耐药性、患者人口统计学特征、BSI结局及抗生素处方实践。
在提交的7427份血培养标本中，病原体阳性率较低（2.1%，156/7427），而血培养污染率较高（10.5%，782/7427）。儿科和新生儿BSI发生率分别为4.5和1.4/1000患者日。革兰阳性菌引起的BSI占主导（59.3%）；金黄色葡萄球菌（26.8%）和大肠埃希菌（21.6%）是常见病原体。患者中位年龄为3个月，男性占多数（57.7%），HIV感染率为12.8%。BSI相关的粗死亡率为7.1%（11/156），新生儿死亡率高于婴儿和儿童（分别为6/40（15.0%）对5/116（4.3%）；p = 0.03），革兰阴性菌血症患者的死亡率高于革兰阳性菌血症患者（分别为6/66（9.1%）对5/89（5.6%）；p = 0.5）。大多数BSI发作是社区获得性的（138/156；88.5%），肺炎克雷伯菌和大肠埃希菌分离株中广谱β-内酰胺酶（ESBL）携带率较高（分别为5/5（100%）和8/33（24.2%））。30.6%的病例（45/147）BSI的抗菌药物管理不当，包括经验性抗生素不正确（46.7%）、联合使用两种抗生素（33.3%）和不适当使用广谱抗生素（17.8%）。
抗菌药物耐药病原体（尤其是产ESBL的肠杆菌科细菌）在社区获得性BSI中很常见。地区医院的儿科临床医生需要持续接受抗生素管理和血培养采样方面的培训。
