Murni Indah K, Duke Trevor, Daley Andrew J, Kinney Sharon, Soenarto Yati
a Department of Paediatrics, Dr Sardjito Hospital/Faculty of Medicine , Universitas Gadjah Mada , Yogyakarta , Indonesia.
b Centre for International Child Health, Department of Paediatrics, University of Melbourne, MCRI, and Paediatric Intensive Care Unit , Royal Children's Hospital , Melbourne , Victoria.
Paediatr Int Child Health. 2019 May;39(2):119-123. doi: 10.1080/20469047.2018.1529459. Epub 2018 Oct 17.
: Nosocomial bloodstream infection (BSI) is associated with high mortality rates. Evaluating factors to predict mortality is important for prevention and improving clinical outcomes. : To evaluate the clinical predictors of mortality in paediatric nosocomial bloodstream infection. : A prospective cohort study was conducted from 1 December 2010 until 28 February 2013 in a teaching hospital in Yogyakarta, Indonesia. All patients admitted consecutively to the paediatric ICU (PICU) and paediatric wards after > 48 h of hospitalisation were eligible. Patients were observed daily to identify the presence of nosocomial BSI based on Centers for Disease Control and Prevention (CDC) criteria. Patients were followed up until they were discharged or died, and predictors of mortality were identified. Logistic regression was used to identify independent predictors. : A total of 2646 patients were recruited, 170 developed nosocomial BSI (6.4%) and 70 of these children died (case fatality rate 41%). Nosocomial BSI was associated with increased mortality with an adjusted OR of 8.5 (95% CI 6.0-12.1). In multivariate analysis, malnutrition, admission to the PICU and use of a central line catheter were independently associated with an increased risk of death with adjusted ORs (95% CI), respectively, of 6.0 (1.6-22.6), 3.2 (1.6-6.7) and 3.1 (1.1-8.7). : The study demonstrates that significant mortality is attributable to nosocomial bloodstream infection. An increased risk of death in children with nosocomial BSI can be identified by simple clinical predictors including malnutrition, admission to the PICU and use of a central line catheter.
医院血流感染（BSI）与高死亡率相关。评估预测死亡率的因素对于预防和改善临床结局很重要。
评估儿童医院血流感染死亡率的临床预测因素。
2010年12月1日至2013年2月28日在印度尼西亚日惹的一家教学医院进行了一项前瞻性队列研究。所有住院超过48小时后连续入住儿科重症监护病房（PICU）和儿科病房的患者均符合条件。根据疾病控制与预防中心（CDC）标准，每天观察患者以确定是否存在医院血流感染。对患者进行随访直至出院或死亡，并确定死亡率的预测因素。采用逻辑回归确定独立预测因素。
共招募了2646例患者，其中170例发生医院血流感染（6.4%），这些儿童中有70例死亡（病死率41%）。医院血流感染与死亡率增加相关，校正后的比值比为8.5（95%置信区间6.0-12.1）。在多变量分析中，营养不良、入住PICU和使用中心静脉导管分别与死亡风险增加独立相关，校正后的比值比（95%置信区间）分别为6.0（1.6-22.6）、3.2（1.6-6.7）和3.1（1.1-8.7）。
该研究表明，医院血流感染可导致显著的死亡率。通过包括营养不良、入住PICU和使用中心静脉导管等简单的临床预测因素，可以识别出医院血流感染儿童死亡风险的增加。
