2010-2017 年日本儿童医院耐多药革兰氏阴性菌血流感染。
Multidrug-resistant Gram-negative Bacterial Bloodstream Infections in Children's Hospitals in Japan, 2010-2017.
机构信息
From the Division of Infectious Diseases, Department of Pediatrics, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan.
Department of Pediatrics, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
出版信息
Pediatr Infect Dis J. 2019 Jul;38(7):653-659. doi: 10.1097/INF.0000000000002273.
BACKGROUND
The risk factors of multidrug-resistant (MDR) Gram-negative bacilli (GNB) bloodstream infection (BSI) are not yet known in children. Our aim was to evaluate risk factors and outcomes associated with MDR GNB BSI in children.
METHODS
Patients with GNB BSI were enrolled between April 2010 and March 2017 at 8 children's hospitals in Japan. Clinical and microbiologic data were collected retrospectively. The risk factors and outcomes of MDR and non-MDR GNB BSI were compared.
RESULTS
In total, 629 GNB BSI episodes met the case definition. The median age and proportion of males were 2 years (interquartile range, 0.3-8.7) and 50.7%, respectively. An underlying disease was found in 94% of patients. The proportion of BSI cases that developed >48 hours after admission was 76.2%. MDR comprised 24.5% of BSI cases. The MDR rate did not change over time (P = 0.540). The effective coverage rate of the initial empiric therapy for the MDR and non-MDR BSI cases was 60.4% and 83.4%, respectively (P < 0.001). The all-cause mortality rate at 28 days for all BSI, MDR-BSI and non-MDR BSI cases was 10.7%, 13.6% and 9.7%, respectively (P = 0.167). MDR BSI was independently associated with cancer chemotherapy within 30 days (odds ratio [OR] 43.90), older age (OR 1.05) and admission to the neonatal ward (OR 0.019).
CONCLUSIONS
One-fourth of GNB BSI cases were MDR. Cancer chemotherapy and older age were risk factors for MDR GNB BSI in children's hospitals. MDR did not increase the all-cause mortality rate.
背景
儿童多重耐药（MDR）革兰氏阴性菌（GNB）血流感染（BSI）的危险因素尚不清楚。我们的目的是评估儿童中与 MDR GNB BSI 相关的危险因素和结局。
方法
2010 年 4 月至 2017 年 3 月，在日本的 8 家儿童医院招募了患有 GNB BSI 的患者。回顾性收集临床和微生物学数据。比较了 MDR 和非 MDR GNB BSI 的危险因素和结局。
结果
共纳入 629 例 GNB BSI 病例。中位年龄和男性比例分别为 2 岁（四分位距，0.3-8.7）和 50.7%。94%的患者存在基础疾病。BSI 病例中有 76.2%是在入院后>48 小时发病的。MDR 占 BSI 病例的 24.5%。MDR 率随时间无变化（P = 0.540）。初始经验性治疗对 MDR 和非 MDR BSI 病例的有效覆盖率分别为 60.4%和 83.4%（P < 0.001）。所有 BSI、MDR-BSI 和非 MDR-BSI 病例的 28 天全因死亡率分别为 10.7%、13.6%和 9.7%（P = 0.167）。MDR BSI 与 30 天内癌症化疗（优势比 [OR] 43.90）、年龄较大（OR 1.05）和入住新生儿病房（OR 0.019）独立相关。
结论
四分之一的 GNB BSI 病例为 MDR。癌症化疗和年龄较大是儿童医院 MDR GNB BSI 的危险因素。MDR 并未增加全因死亡率。
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