Chen Jian, Huang Haixin, Zhang Ruichen, Fu Yueqiang, Jing Chunmei
Department of Critical Care Medicine, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Rare Diseases in Infection and Immunity, Chongqing, China.
Department of Pediatric Critical Care Medicine, Sichuan Provincial Women's and Children's Hospital, Chengdu, China.
Front Cell Infect Microbiol. 2025 Feb 3;15:1492208. doi: 10.3389/fcimb.2025.1492208. eCollection 2025.
Bloodstream infection (BSI)-induced severe sepsis is a common cause of mortality, frequently resulting in septic shock and multiple organ dysfunction syndrome (MODS). This study aimed to analyze mortality risk factors and summarize pathogen characteristics associated with BSI-induced severe sepsis in the pediatric intensive care unit (PICU).
This retrospective study was conducted at a tertiary pediatric hospital between January 2015 and December 2023, encompassing children with BSI-induced severe sepsis in the PICU. Clinical characteristics, laboratory parameters, pathogen characteristics, and drug resistance profiles of the patients were collected. Clinical and laboratory indicators along with pathogen characteristics were summarized. Logistic regression analysis was employed to identify independent risk factors associated with 28-day mortality.
A total of 192 patients with bloodstream infection (BSI)-induced severe sepsis were identified, with a 28-day in-hospital mortality rate of 36.98% (71/192). The incidence of septic shock (42.1% . 69%, P < 0.001) and AKI (14% . 31%, P = 0.005) was significantly lower in the survival group compared to the non-survival group. In multivariate analysis, independent risk factors for 28-day mortality were the pediatric sequential organ failure assessment (pSOFA) score (OR 1.176; 95% CI: 1.046-1.321, = 0.007) and the P/F value (OR 0.994; 95% CI: 0.991-0.997, 0.001). Double organism growth was detected in 8 cultures, and a total of 200 pathogenic bacteria were isolated from all blood cultures. Of these, 110 strains (55.0%) were Gram-negative bacteria, 88 strains (44.0%) were gram-positive bacteria, and 2 strains (1.0%) were . The most commonly isolated pathogens were . The detection rate of carbapenem resistance (CR) in (66.7%) was higher than that in (15.4%). The detection rates of extended-spectrum cephalosporin resistance (ECR) and fluoroquinolone resistance (FQR) in () were higher than those in .
In the PICU, higher mortality was observed in children with BSI-induced severe sepsis who presented with elevated pSOFA scores and low P/F values. exhibited the highest levels of CR and FQR, while demonstrated the highest level of ECR.
血流感染（BSI）所致严重脓毒症是常见的死亡原因，常导致感染性休克和多器官功能障碍综合征（MODS）。本研究旨在分析儿科重症监护病房（PICU）中BSI所致严重脓毒症的死亡风险因素，并总结相关病原体特征。
本回顾性研究于2015年1月至2023年12月在一家三级儿科医院进行，纳入PICU中因BSI导致严重脓毒症的儿童。收集患者的临床特征、实验室参数、病原体特征和耐药谱。总结临床和实验室指标以及病原体特征。采用逻辑回归分析确定与28天死亡率相关的独立风险因素。
共确定192例因血流感染（BSI）导致严重脓毒症的患者，28天院内死亡率为36.98%（71/192）。与未存活组相比，存活组感染性休克（42.1%对69%，P<0.001）和急性肾损伤（AKI，14%对31%，P = 0.005）的发生率显著更低。多因素分析中，28天死亡率的独立风险因素为儿科序贯器官衰竭评估（pSOFA）评分（OR 1.176；95%CI：1.046 - 1.321，P = 0.007）和P/F值（OR 0.994；95%CI：0.991 - 0.997，P<0.001）。8份培养物检测到双菌生长，所有血培养共分离出200株病原菌。其中，110株（55.0%）为革兰阴性菌，88株（44.0%）为革兰阳性菌，2株（1.0%）为……最常分离出的病原体为……[具体病原体名称缺失]中碳青霉烯耐药（CR）的检出率（66.7%）高于[另一病原体名称缺失]（15.4%）。[具体病原体名称缺失]中广谱头孢菌素耐药（ECR）和氟喹诺酮耐药（FQR）的检出率高于[另一病原体名称缺失]。
在PICU中，pSOFA评分升高和P/F值降低的BSI所致严重脓毒症患儿死亡率更高。[具体病原体名称缺失]的CR和FQR水平最高，而[另一病原体名称缺失]的ECR水平最高。
