传染病会诊对儿童金黄色葡萄球菌菌血症治疗和预后的影响。
Impact of Infectious Diseases Consultation on Management and Outcome of Staphylococcus aureus Bacteremia in Children.
机构信息
Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Sydney, New South Wales, Australia.
Infectious Diseases Unit, Paediatric Department, Suhar Hospital, Suhar, Oman.
出版信息
J Pediatric Infect Dis Soc. 2021 May 28;10(5):569-575. doi: 10.1093/jpids/piaa155.
BACKGROUND
To examine the impact of infectious diseases consultation (IDC) on the management and outcome of Staphylococcus aureus bacteremia (SAB) in children.
METHODS
A retrospective cohort study of children with SAB at a teritary pediatric hospital (January 2009-June 2015) identified by medical record review as to whether they received an IDC for SAB at the discretion of the admitting physician or surgeon was conducted. Differences in management and outcomes for those with and without IDC were evaluated, and multivariate regression analysis was used to determine factors associated with cure.
RESULTS
There were 100 patients included in the analysis. Fifty-five patients received IDC and 45 had no IDC (NIDC). Appropriate directed therapy within 24 hours (54/55 = 98.2% vs 34/45 = 75.6%, P < .01), choice (54/55 = 98.2% vs 37/45 = 82.2%, P < .01), dose (54/55 = 98.2% vs 36/45 = 80%, P < .01), and duration (52/55 = 94.5% vs 24/45 = 53.3%, P < .01) of directed antibiotic therapy were appropriate in more IDC group patients. Achievement of source control in indicated cases was also more common in the IDC group (28/32 = 87.5% vs 5/26 = 19.1%, P < .01). Appropriate investigation with repeat blood cultures and echocardiograms was not significantly different. All 55 patients in the IDC group had a complete response (cure) compared with 40 of the 45 (88.9%) patients in the NIDC group: 2 patients died and 3 patients had a relapse of infection with subsequent cure. In multivariate regression analysis, methicillin-susceptible SAB and IDC were factors independently associated with cure.
CONCLUSIONS
Children who received IDC for SAB in a tertiary pediatric setting were more likely to have appropriate investigations and management and had improved outcomes.
背景
研究传染病会诊（IDC）对儿童金黄色葡萄球菌菌血症（SAB）的治疗和预后的影响。
方法
通过病历回顾，对 2009 年 1 月至 2015 年 6 月在一家儿科三级医院确诊为 SAB 的患儿进行回顾性队列研究，确定是否根据主治医生或外科医生的判断为患儿提供 IDC。评估有和没有 IDC 的患儿的治疗和预后差异，并采用多变量回归分析确定与治愈相关的因素。
结果
分析中纳入 100 例患儿。55 例患儿接受 IDC，45 例患儿未接受 IDC（NIDC）。24 小时内接受适当的靶向治疗（54/55=98.2% vs 34/45=75.6%，P<0.01）、选择合适的抗生素（54/55=98.2% vs 37/45=82.2%，P<0.01）、剂量（54/55=98.2% vs 36/45=80%，P<0.01）和疗程（52/55=94.5% vs 24/45=53.3%，P<0.01）适当的靶向抗生素治疗在 IDC 组患儿中更为常见。在有指征的病例中，达到源头控制的情况在 IDC 组也更为常见（28/32=87.5% vs 5/26=19.1%，P<0.01）。适当的调查，包括重复血培养和超声心动图检查，两组之间无显著差异。IDC 组的 55 例患儿全部完全缓解（治愈），而 NIDC 组的 45 例患儿中只有 40 例（88.9%）治愈：2 例死亡，3 例感染复发，随后治愈。多变量回归分析显示，耐甲氧西林金黄色葡萄球菌和 IDC 是与治愈相关的独立因素。
结论
在儿科三级医疗机构中，对 SAB 患儿进行 IDC 治疗更可能进行适当的检查和管理，并改善预后。
Zotero 插件