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与耐甲氧西林金黄色葡萄球菌感染相关且需要体外生命支持的脓毒症儿科患者的结局:一项体外生命支持组织(ELSO)数据库研究

Outcomes of Pediatric Patients With Sepsis Related to and Methicillin-Resistant Infections Requiring Extracorporeal Life Support: An ELSO Database Study.

作者信息

Foster Cortney, Bagdure Dayanand, Custer Jason, Holloway Adrian, Rycus Peter, Day Jenni, Bhutta Adnan

机构信息

Division of Pediatric Critical Care, Department of Pediatrics, University of Maryland, Baltimore, MD, United States.

ELSO, Ann Arbor, MI, United States.

出版信息

Front Pediatr. 2021 Oct 8;9:706638. doi: 10.3389/fped.2021.706638. eCollection 2021.

Abstract

Extracorporeal membrane oxygenation (ECMO) is increasingly utilized for pediatric sepsis unresponsive to steroids and inotropic support. Outcomes of children with sepsis are influenced by the type of pathogen causing their illness. To determine if the outcomes of children with sepsis receiving ECMO differed according to microbial sensitivity (Methicillin-resistant [MRSA] vs. Methicillin-sensitive [MSSA]). Retrospective case-matched cohort study of children (0-<18 years) with sepsis reported to the ELSO registry from more than 995 centers. Inclusion criteria were age 0-18 years, laboratory diagnosis of Staphylococcal infection, clinical diagnosis of sepsis, and ECMO deployment. Exclusion criteria were no laboratory diagnosis of Staphylococcal infection. We compared patient demographics, pre-ECMO management and outcomes of those with MRSA vs. MSSA using Chi-Square test, with independent samples -test used to test to compare continuous variables. In our study cohort of 308 patients, 160 (52%) had MSSA and 148 (48%) MRSA with an overall survival rate of 41.5%. There were no differences in the age group ( = 0.76), gender distribution ( = 0.1) or racial distribution ( = 0.58) between the two groups. value for racial distribution should be 0.058. There were 91 (56.8%) deaths in the MSSA group and 89 (60.1%) deaths ( = 0.56) in the MRSA group. Duration on ECMO ( = 0.085) and the time from intubation to ECMO ( = 0.37) were also similar in the two groups. Survival with MSSA sepsis and MRSA sepsis did not improve significantly over the 20 years evaluated despite an increase in ECMO utilization. In this multi-center retrospective study, there were no differences in outcomes for children receiving ECMO support with sepsis according to microbial methicillin sensitivity. There was no significant increase in survival among patients with MRSA and MSSA infections receiving ECMO in the last 20 years.

摘要

体外膜肺氧合(ECMO)越来越多地用于对类固醇和血管活性药物支持无反应的小儿脓毒症。脓毒症患儿的预后受致病病原体类型的影响。为了确定接受ECMO治疗的脓毒症患儿的预后是否因微生物敏感性(耐甲氧西林金黄色葡萄球菌[MRSA]与甲氧西林敏感金黄色葡萄球菌[MSSA])而有所不同。对来自995多个中心向体外生命支持组织(ELSO)登记处报告的脓毒症患儿(0至<18岁)进行回顾性病例匹配队列研究。纳入标准为年龄0至18岁、葡萄球菌感染的实验室诊断、脓毒症的临床诊断以及ECMO的应用。排除标准为无葡萄球菌感染的实验室诊断。我们使用卡方检验比较了MRSA与MSSA患者的人口统计学特征、ECMO前管理和预后,使用独立样本t检验比较连续变量。在我们的308例患者研究队列中,160例(52%)为MSSA,148例(48%)为MRSA,总生存率为41.5%。两组之间的年龄组(P = 0.76)、性别分布(P = 0.1)或种族分布(P = 0.58)无差异。种族分布的P值应为0.058。MSSA组有91例(56.8%)死亡,MRSA组有89例(60.1%)死亡(P = 0.56)。两组的ECMO使用时间(P = 0.085)和从插管到ECMO的时间(P = 0.37)也相似。尽管ECMO的使用有所增加,但在评估的20年中,MSSA脓毒症和MRSA脓毒症的生存率并未显著提高。在这项多中心回顾性研究中,接受ECMO支持的脓毒症患儿的预后根据微生物对甲氧西林的敏感性没有差异。在过去20年中,接受ECMO治疗的MRSA和MSSA感染患者的生存率没有显著提高。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2580/8531717/27da9ffa33dd/fped-09-706638-g0001.jpg

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