Pediatric Emergency Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain.
Pediatric Emergency Department, Hospital Cruces (Barakaldo), Vizcaya, Spain.
Pediatr Infect Dis J. 2022 Jun 1;41(6):455-459. doi: 10.1097/INF.0000000000003520. Epub 2022 May 6.
To describe the infants presenting to pediatric emergency departments (PEDs) and diagnosed with group B Streptococcus (GBS) late-onset disease (LOD) bacteremia and identify risk factors for severe infection and pediatric intensive care unit (PICU) admission.
Observational study and subanalysis of a multicenter prospective registry. Setting: pediatric emergency department. Inclusion criteria: infants between 7 and 89 days of age with positive blood culture for GBS seen between 2011 and 2016 at any of 22 Spanish PEDs. Main outcome: risk factors (clinical and laboratory variables) for severe infection (sepsis/septic shock or meningitis) and PICU admission. Second, the prevalence of poor outcomes (acute complications, sequelae or death).
Among 118 patients with LOD, 74 (62.7%) presented a severe infection: 66 sepsis/septic shock (11 with associated meningitis) and 8 meningitis. Thirty-five patients (29.7%) were admitted to a PICU. An altered Pediatric Assessment Triangle (PAT) upon arrival and leukopenia were the only independent risk factors for severe infection [odds ratio (OR): 43.6; 95% confidence interval (CI): 8.1-235.7, P < 0.01] and PICU admission (OR: 11.6; 95% CI: 1.5-91.4; P < 0.019), respectively. Six patients (5.1%) developed a poor outcome, including 2 deaths (1.7%); all had an altered PAT, elevated procalcitonin (range 4.7-100 ng/ml), and were diagnosed with sepsis/septic shock and admitted to a PICU. Four developed leukopenia.
Infants with GBS LOD frequently develop sepsis/septic shock and bacterial meningitis, associated with non-negligible morbidity and mortality. Clinical appearance was the only risk factor for severe infection, whereas leukopenia was related to PICU admission.
描述在儿科急诊部门（PED）就诊并被诊断为 B 群链球菌（GBS）晚发型疾病（LOD）菌血症的婴儿，并确定严重感染和儿科重症监护病房（PICU）入院的危险因素。
观察性研究和多中心前瞻性登记的亚分析。设置：儿科急诊室。纳入标准：2011 年至 2016 年间，22 家西班牙 PED 中的任何一家就诊的年龄在 7 至 89 天之间的血培养阳性的 GBS 婴儿。主要结局：严重感染（败血症/感染性休克或脑膜炎）和 PICU 入院的危险因素（临床和实验室变量）。其次，不良结局（急性并发症、后遗症或死亡）的发生率。
在 118 例 LOD 患儿中，74 例（62.7%）发生严重感染：66 例败血症/感染性休克（11 例伴有脑膜炎）和 8 例脑膜炎。35 例（29.7%）患儿入住 PICU。入院时改变的儿科评估三角（PAT）和白细胞减少是严重感染（比值比[OR]：43.6；95%置信区间[CI]：8.1-235.7，P <0.01）和 PICU 入院（OR：11.6；95%CI：1.5-91.4；P <0.019）的唯一独立危险因素。6 例（5.1%）患儿发生不良结局，包括 2 例死亡（1.7%）；所有患儿均有改变的 PAT、降钙素原升高（范围 4.7-100ng/ml），诊断为败血症/感染性休克并入住 PICU。4 例患儿出现白细胞减少。
GBS LOD 的婴儿常发生败血症/感染性休克和细菌性脑膜炎，与不可忽视的发病率和死亡率相关。临床表现是严重感染的唯一危险因素，而白细胞减少与 PICU 入院相关。
