评价儿科溺水人群的抗菌药物利用情况。

Evaluation of Antimicrobial Utilization in the Pediatric Drowning Population.

机构信息

Texas Children's Hospital, Department of Pharmacy, Houston, Texas, USA.

Baylor College of Medicine, Department of Pediatrics, Houston, Texas, USA.

出版信息

J Pediatric Infect Dis Soc. 2021 Mar 26;10(2):179-182. doi: 10.1093/jpids/piaa021.

DOI:10.1093/jpids/piaa021

PMID:32154867

Abstract

BACKGROUND

Management of pediatric drowning often includes evaluation and treatment of infectious disease. There are few data describing the infections associated with pediatric drowning.

METHODS

A descriptive retrospective study was designed, and patients aged < 19 years admitted for > 24 hours to our institution after a drowning were included from January 2011 through June 30, 2017. Data collection included patient demographics, submersion injury details, resuscitation details, patient admission details, chest radiograph on admission, use of intubation and mechanical ventilation, hospital length of stay, culture data, antimicrobial use, and mortality. Descriptive statistical methods (mean and standard deviation, median and range, percentage) were used to characterize the patient population, and Fisher exact test was used to evaluate the association between antimicrobial use in the first 72 hours of admission and mortality.

RESULTS

A total of 114 patients met study criteria (male, 59.7%; median age, 3.7 years [range, 0.15-17.79 years]). Median hospital length of stay was 2 days (range, 1-60 days). Intensive care unit admission occurred in 80.7%, intubation occurred in 46.5%, and mortality was 18.4%. The most common submersion location was a pool (76.3% [n = 87]) with water primarily characterized as freshwater (82.5% [n = 94]). Reported submersion time for the majority of patients was < 5 minutes (54.4%) with cardiopulmonary resuscitation in 78.1%. In the first 72 hours after admission, culture were obtained in 40 patients (35.1%), and 27.5% of these cultures were positive. The primary organisms identified were consistent oropharyngeal flora. Antimicrobials were initiated in 50% of the patient population with clindamycin as most common. There was not a significant association between antimicrobial use in the first 72 hours after admission and mortality (17.2% vs 19.6%, P = .81).

CONCLUSIONS

Infectious disease associated with pediatric drowning in pools is uncommon. Empiric use of antimicrobials does not appear to affect outcomes.

摘要

背景

小儿溺水的处理通常包括传染病的评估和治疗。有关与小儿溺水相关的感染的资料很少。

方法

设计了一项描述性回顾性研究，纳入 2011 年 1 月至 2017 年 6 月 30 日在我院住院时间超过 24 小时的<19 岁溺水患者。数据收集包括患者人口统计学资料、浸溺伤详情、复苏详情、入院详情、入院时的胸部 X 线片、气管插管和机械通气的使用、住院时间、培养数据、抗菌药物使用和死亡率。采用描述性统计方法（均值和标准差、中位数和范围、百分比）对患者人群进行特征描述，采用 Fisher 确切检验评估入院后 72 小时内抗菌药物使用与死亡率之间的关系。

结果

共有 114 例患者符合研究标准（男性占 59.7%；中位年龄为 3.7 岁[范围为 0.15-17.79 岁]）。中位住院时间为 2 天（范围为 1-60 天）。80.7%的患者入住重症监护病房，46.5%的患者插管，死亡率为 18.4%。最常见的溺水地点是游泳池（76.3%[87 例]），水中主要为淡水（82.5%[94 例]）。大多数患者的溺水时间<5 分钟（54.4%），78.1%的患者进行了心肺复苏。入院后 72 小时内，40 例（35.1%）患者获得培养结果，其中 27.5%的培养结果阳性。主要鉴定的病原体为一致的口咽部菌群。50%的患者开始使用抗菌药物治疗，最常用的是克林霉素。入院后 72 小时内使用抗菌药物与死亡率之间无显著关联（17.2%比 19.6%，P=0.81）。