Department of General Pediatrics, Tokyo Metropolitan Children's Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo, 183-8561, Japan.
Clinical Research Support Center, Tokyo Metropolitan Children's Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo, 183-8561, Japan.
J Infect Chemother. 2021 Aug;27(8):1198-1204. doi: 10.1016/j.jiac.2021.03.016. Epub 2021 Apr 1.
To assess the risk factors of bacteremia in children hospitalized with community-acquired pneumonia (CAP).
The present, nested, case-control study enrolled a cohort of patients with CAP aged < 18 years who were hospitalized at Tokyo Metropolitan Children's Medical Center or Tama-Hokubu Medical Center between March 2010 and February 2018. Among the cohort with blood cultures (BCs), patients with bacteremia were identified and matched with five control patients based on their treatment facility, underlying disease, and age. Conditional logistic regression was used to calculate the odds ratios (ORs) of bacteremia for risk factor candidates.
BCs were obtained for 2,383 (84%) of the 2,853 patients in the CAP cohort. Of those with BCs, 34 (1.4%) had bacteremia. S. pneumoniae and H. influenzae accounted for 26 (76%) and four (12%) instances of the bacteremia pathogens, respectively. Bacteremia occurred more frequently among patients hospitalized in the spring than during other seasons (P = 0.022). On multivariate analysis, the severity of pneumonia was not associated with bacteremia incidence (OR: 0.92 [0.30-2.85]) while a white blood cell count > 16,000/μL (OR: 5.90 [2.14-16.3]) was shown to be a significant risk factor. The OR of the need for a ventilator on admission day was significantly high (28.4 [3.02-1374]) on univariate analysis, but the subject pool was too small to determine its significance on multivariate analysis.
The results of the present study supported BC collection in patients with leukocytosis and in those requiring ventilator use on admission.
评估儿童社区获得性肺炎（CAP）住院患者菌血症的危险因素。
本病例对照嵌套研究纳入了 2010 年 3 月至 2018 年 2 月期间在东京都儿童医疗中心或多摩北部医疗中心住院的年龄<18 岁的 CAP 患者队列。在有血培养（BC）的患者中，根据治疗机构、基础疾病和年龄，确定了菌血症患者，并与 5 名对照患者匹配。使用条件逻辑回归计算菌血症危险因素的优势比（OR）。
CAP 队列的 2853 例患者中，有 2383 例（84%）进行了 BC。在进行 BC 的患者中，34 例（1.4%）有菌血症。肺炎链球菌和流感嗜血杆菌分别占菌血症病原体的 26 例（76%）和 4 例（12%）。春季住院患者菌血症发生率高于其他季节（P=0.022）。多变量分析显示，肺炎严重程度与菌血症发生率无关（OR：0.92[0.30-2.85]），而白细胞计数>16,000/μL（OR：5.90[2.14-16.3]）是一个显著的危险因素。入院当天需要呼吸机的 OR 在单变量分析中显著升高（28.4[3.02-1374]），但由于研究对象数量太少，多变量分析无法确定其意义。
本研究结果支持对白细胞增多和入院时需要使用呼吸机的患者进行 BC 采集。
