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2014-2017 年,因社区获得性金黄色葡萄球菌血症而收治重症监护病房的儿科患者的死亡与入院的关系。

Relationship between death and admission of pediatric patients to intensive care due to Staphylococcus aureus bacteremia acquired in the community, 2014-2017.

机构信息

Departamento de Medicina, Universidad de Nariño, Pasto, Colombia; Hospital Infantil Los Ángeles, Pasto, Colombia.

Departamento de Medicina, Universidad de Nariño, Pasto, Colombia.

出版信息

Biomedica. 2021 Mar 19;41(1):145-152. doi: 10.7705/biomedica.5275.

Abstract

Introduction: The bacteremia caused by Staphylococcus aureus acquired in the community (SA-AC) is a frequent pathology in pediatrics and it is considered a public health problem generating high rates of morbidity, mortality, and bacterial resistance. Objectives: To analyze the factors related to death and admission to intensive care units of patients under 18 years of age with AC-SA bacteremia admitted to the Hospital Infantil Los Ángeles, Pasto, Colombia, from 2014 to 2017. Material and methods: We conducted a descriptive, transversal, cross-sectional observational study. We analyzed 86 patients with bacteremia due to AC-SA that met the inclusion criteria for the study using a multivariate logistic regression model. Results: Of the 86 cases, 25.6% died and 40.7% entered the intensive care unit. The resistance to methicillin was 52.3%. The main foci of infection were the soft tissues and the osteoarticular and respiratory systems; 32.6% of patients came from the Pacific area of Nariño. The predominant ethnic groups were the mestizo and the indigenous. Indigenous patients had higher mortality compared to the mestizo and Afro-Colombian ethnic groups. The multivariate analysis showed significance in terms of death for endocarditis (adjusted OR=20; CI: 1.5-254; p=0.02) while no statistical significance was registered for the admission to the intensive care unit. Conclusions: The AC-SA led to high mortality and admission to the intensive care unit; 52.3% of strains were resistant and resistance to methicillin showed higher mortality, although the mortality with sensitive strains was considerable. Endocarditis showed fairly high mortality. The empirical therapy should be adjusted when bacteremia due to AC-SA is suspected.

摘要

引言

社区获得性金黄色葡萄球菌(SA-AC)菌血症是儿科常见疾病,被认为是一个公共卫生问题,导致发病率、死亡率和细菌耐药率高。目的:分析 2014 年至 2017 年哥伦比亚帕斯托市 Los Ángeles 儿童医院收治的 18 岁以下 AC-SA 菌血症患者死亡和入住重症监护病房(ICU)的相关因素。材料与方法:我们进行了一项描述性、横断面、交叉观察性研究。我们使用多变量逻辑回归模型分析了符合研究纳入标准的 86 例 AC-SA 菌血症患者。结果:86 例患者中,25.6%死亡,40.7%进入 ICU。耐甲氧西林的比例为 52.3%。主要感染灶为软组织、骨和关节以及呼吸系统;32.6%的患者来自纳里尼奥的太平洋地区。主要种族群体为混血儿和土著人。与混血儿和非裔哥伦比亚人相比,土著患者的死亡率更高。多变量分析显示,心内膜炎与死亡相关(调整后的 OR=20;95%CI:1.5-254;p=0.02),而入住 ICU 与死亡无统计学意义。结论:AC-SA 导致高死亡率和入住 ICU;52.3%的菌株耐药,对甲氧西林的耐药性导致死亡率更高,尽管敏感菌株的死亡率也相当高。心内膜炎死亡率相当高。当怀疑 AC-SA 菌血症时,应调整经验性治疗。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/292c/8055594/477ed69229a2/2590-7379-bio-41-01-5275-f1.jpg

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