Girona-Alarcón Mònica, Fresán Elena, Garcia-Garcia Ana, Bobillo-Perez Sara, Balaguer Monica, Felipe Aida, Esteban Maria Esther, Jordan Iolanda
Paediatric Intensive Care Unit, Institut de Recerca Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain.
Immunological and Respiratory Disorders in the Paediatric Critical Patient Research Group, Institut de Recerca Hospital Sant Joan de Déu, Hospital Sant Joan de Déu, Barcelona, Spain.
Acta Paediatr. 2021 Jan;110(1):203-209. doi: 10.1111/apa.15342. Epub 2020 May 21.
Multidrug-resistant bacterial infections are a public health problem worldwide. However, most of the information available refers to adults. The main objectives were to determine the incidence, risk factors, and outcomes for device-associated infections, especially those involving multidrug-resistant bacteria.
This is a prospective, observational study. Children aged ≥1 month and <18 years admitted to the paediatric intensive care unit from 2008 to 2017, with a device-associated infection microbiologically confirmed were included. Patients infected with resistant bacteria were compared with those who had a drug-susceptible infection.
The study included 213 patients. Out of all the device-associated infections, 22% (48 patients) were caused by multidrug-resistant bacteria. The most frequent were extended-spectrum beta-lactamase (ESBL)-producing enterobacteria. Cardiovascular diseases, age under 1year, comorbidity, prolonged use of invasive device, and length of stay until infection were risk factors for resistant bacteria, but not specifically for ESBL-producing bacteria. Length of stay and mortality was increased in patients with multidrug-resistant bacteria.
Being under 1-year-old and having a cardiovascular disease were the two major risk factors for resistant bacterial infection. ESBL-producing bacteria were the most frequent multidrug-resistant agents. However, patients with ESBL-producing bacteria did not have any additional risk factors, so they may have been colonised in the community.
耐多药细菌感染是全球范围内的一个公共卫生问题。然而，现有的大多数信息都针对成年人。主要目标是确定与器械相关感染的发生率、危险因素和结局，尤其是那些涉及耐多药细菌的感染。
这是一项前瞻性观察性研究。纳入2008年至2017年入住儿科重症监护病房、年龄≥1个月且<18岁、经微生物学确诊为与器械相关感染的儿童。将感染耐药菌的患者与感染药敏菌的患者进行比较。
该研究纳入了213例患者。在所有与器械相关的感染中，22%（48例患者）由耐多药细菌引起。最常见的是产超广谱β-内酰胺酶（ESBL）的肠杆菌。心血管疾病、1岁以下、合并症、侵入性器械的长期使用以及感染前的住院时间是耐药菌感染的危险因素，但并非产ESBL细菌的特异性危险因素。耐多药细菌感染患者的住院时间和死亡率增加。
1岁以下和患有心血管疾病是耐药菌感染的两个主要危险因素。产ESBL细菌是最常见的耐多药病原体。然而，产ESBL细菌感染的患者没有任何其他危险因素，因此他们可能是在社区中定植的。
