Division of Pediatric Emergency Medicine, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA; Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA.
Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA.
J Pediatr. 2021 May;232:207-213.e2. doi: 10.1016/j.jpeds.2021.01.005. Epub 2021 Jan 13.
To determine the association between bacteremia and vaccination status in children aged 2-36 months presenting to a pediatric emergency department.
Retrospective cohort study of children aged 2-36 months with blood cultures obtained in the pediatric emergency department between January 2013 and December 2017. The exposure of interest was immunization status, defined as number of Haemophilus influenzae type B (Hib) and Streptococcus pneumoniae vaccinations, and the main outcome positive blood culture. Subjects with high-risk medical conditions were excluded.
Of 5534 encounters, 4742 met inclusion criteria. The incidence of bacteremia was 1.5%. The incidence of contaminated blood culture was 5.0%. The relative risk of bacteremia was 0.79 (95% CI 0.39-1.59) for unvaccinated and 1.20 (95% CI 0.52-2.75) for undervaccinated children relative to those who had received age-appropriate vaccines. Five children were found to have S pneumoniae bacteremia and 1 child had Hib bacteremia; all of these subjects had at least 3 sets of vaccinations. No vaccine preventable pathogens were isolated from blood cultures of unvaccinated children. We found no S pneumoniae or Hib in children 2-6 months of age who were not fully vaccinated due to age (95% CI 0-0.13%) and the contamination rate in this group was high compared with children 7-36 months (6.6% vs 3.7%).
Bacteremia in young children is an uncommon event. Contaminated blood cultures were more common than pathogens. Bacteremia from S pneumoniae or Hib is uncommon and, in this cohort, was independent of vaccine status.
确定在儿科急诊就诊的 2-36 个月龄儿童中菌血症与疫苗接种状况之间的关联。
对 2013 年 1 月至 2017 年 12 月期间在儿科急诊进行血培养的 2-36 个月龄儿童进行回顾性队列研究。感兴趣的暴露因素为免疫接种状况，定义为 Hib 和肺炎链球菌疫苗接种次数，主要结局为阳性血培养。排除具有高危医疗条件的患儿。
在 5534 次就诊中，有 4742 次符合纳入标准。菌血症的发生率为 1.5%。污染血培养的发生率为 5.0%。与接受了适宜年龄疫苗接种的儿童相比，未接种疫苗的儿童菌血症的相对风险为 0.79（95%CI 0.39-1.59），而接种不足的儿童为 1.20（95%CI 0.52-2.75）。有 5 例儿童血培养发现肺炎链球菌菌血症，1 例儿童 Hib 菌血症；所有这些患儿至少接受了 3 剂疫苗接种。未接种疫苗的儿童血培养中未分离出可通过疫苗预防的病原体。我们发现，由于年龄原因未完全接种疫苗的 2-6 月龄儿童（95%CI 0-0.13%）中未检出肺炎链球菌或 Hib，且该组的污染率高于 7-36 月龄儿童（6.6%比 3.7%）。
幼儿菌血症是一种罕见事件。污染血培养比病原体更常见。肺炎链球菌或 Hib 引起的菌血症并不常见，且在本队列中与疫苗接种状况无关。
