Pediatrics Department, Translational Pediatrics and Infectious Diseases Section, Santiago de Compostela, Spain; Genetics- Vaccines- Infectious Diseases and Pediatrics research group GENVIP, Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela, Spain.
Genetics- Vaccines- Infectious Diseases and Pediatrics research group GENVIP, Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela, Spain; Unidade de Xenética, Departamento de Anatomía Patolóxica e Ciencias Forenses, Instituto de Ciencias Forenses, Facultade de Medicina, Universidade de Santiago de Compostela, Galicia, Spain; GenPoB Research Group, Instituto de Investigaciones Sanitarias (IDIS), Hospital Clínico Universitario de Santiago (SERGAS), Galicia, Spain.
Lancet Child Adolesc Health. 2018 Jun;2(6):404-414. doi: 10.1016/S2352-4642(18)30113-5. Epub 2018 Apr 28.
Sepsis and severe focal infections represent a substantial disease burden in children admitted to hospital. We aimed to understand the burden of disease and outcomes in children with life-threatening bacterial infections in Europe.
The European Union Childhood Life-threatening Infectious Disease Study (EUCLIDS) was a prospective, multicentre, cohort study done in six countries in Europe. Patients aged 1 month to 18 years with sepsis (or suspected sepsis) or severe focal infections, admitted to 98 participating hospitals in the UK, Austria, Germany, Lithuania, Spain, and the Netherlands were prospectively recruited between July 1, 2012, and Dec 31, 2015. To assess disease burden and outcomes, we collected demographic and clinical data using a secured web-based platform and obtained microbiological data using locally available clinical diagnostic procedures.
2844 patients were recruited and included in the analysis. 1512 (53·2%) of 2841 patients were male and median age was 39·1 months (IQR 12·4-93·9). 1229 (43·2%) patients had sepsis and 1615 (56·8%) had severe focal infections. Patients diagnosed with sepsis had a median age of 27·6 months (IQR 9·0-80·2), whereas those diagnosed with severe focal infections had a median age of 46·5 months (15·8-100·4; p<0·0001). Of 2844 patients in the entire cohort, the main clinical syndromes were pneumonia (511 [18·0%] patients), CNS infection (469 [16·5%]), and skin and soft tissue infection (247 [8·7%]). The causal microorganism was identified in 1359 (47·8%) children, with the most prevalent ones being Neisseria meningitidis (in 259 [9·1%] patients), followed by Staphylococcus aureus (in 222 [7·8%]), Streptococcus pneumoniae (in 219 [7·7%]), and group A streptococcus (in 162 [5·7%]). 1070 (37·6%) patients required admission to a paediatric intensive care unit. Of 2469 patients with outcome data, 57 (2·2%) deaths occurred: seven were in patients with severe focal infections and 50 in those with sepsis.
Mortality in children admitted to hospital for sepsis or severe focal infections is low in Europe. The disease burden is mainly in children younger than 5 years and is largely due to vaccine-preventable meningococcal and pneumococcal infections. Despite the availability and application of clinical procedures for microbiological diagnosis, the causative organism remained unidentified in approximately 50% of patients.
European Union's Seventh Framework programme.
脓毒症和严重局部感染是导致儿童住院的主要疾病负担。本研究旨在了解欧洲危及生命的细菌性感染患儿的疾病负担和结局。
欧洲儿童危及生命感染性疾病研究（EUCLIDS）是一项在欧洲 6 个国家进行的前瞻性、多中心、队列研究。2012 年 7 月 1 日至 2015 年 12 月 31 日期间，在英国、奥地利、德国、立陶宛、西班牙和荷兰的 98 家参与医院，前瞻性招募年龄 1 个月至 18 岁、患有脓毒症（或疑似脓毒症）或严重局部感染的患儿。为了评估疾病负担和结局，我们使用安全的网络平台收集了人口统计学和临床数据，并使用当地现有的临床诊断程序获取了微生物学数据。
共纳入 2844 例患儿，其中 1512 例（53.2%）为男性，中位年龄为 39.1 个月（IQR 12.4-93.9）。1229 例（43.2%）患儿诊断为脓毒症，1615 例（56.8%）患儿诊断为严重局部感染。脓毒症患儿的中位年龄为 27.6 个月（IQR 9.0-80.2），而严重局部感染患儿的中位年龄为 46.5 个月（15.8-100.4；P<0.0001）。在整个队列的 2844 例患儿中，主要临床综合征为肺炎（511 例[18.0%]）、中枢神经系统感染（469 例[16.5%]）和皮肤软组织感染（247 例[8.7%]）。在 2844 例患儿中，1359 例（47.8%）患儿的病原体得到了鉴定，最常见的病原体为脑膜炎奈瑟菌（259 例[9.1%]），其次为金黄色葡萄球菌（222 例[7.8%]）、肺炎链球菌（219 例[7.7%]）和 A 组链球菌（162 例[5.7%]）。1070 例（37.6%）患儿需要入住儿科重症监护病房。在 2469 例有结局数据的患儿中，57 例（2.2%）死亡：7 例为严重局部感染患儿，50 例为脓毒症患儿。
在欧洲，因脓毒症或严重局部感染住院的患儿死亡率较低。疾病负担主要集中在 5 岁以下儿童，主要由可通过疫苗预防的脑膜炎奈瑟菌和肺炎链球菌感染引起。尽管已经应用了微生物诊断的临床程序，但仍有约 50%的患儿无法明确病因。
欧盟第七框架计划。
