一项关于儿童革兰氏阴性菌血症的前瞻性研究。

A prospective study of Gram-negative bacteremia in children.

作者信息

Levy I, Leibovici L, Drucker M, Samra Z, Konisberger H, Ashkenazi S

机构信息

Department of Pediatrics, Schneider Children's Medical Center, Petah Tiqva, Israel.

出版信息

Pediatr Infect Dis J. 1996 Feb;15(2):117-22. doi: 10.1097/00006454-199602000-00006.

DOI:10.1097/00006454-199602000-00006

PMID:8822283

Abstract

BACKGROUND

Hospital- and community-acquired Gram-negative bacteremia is a significant cause of mortality and morbidity in pediatric medical centers. Gram-negative organisms are isolated in > 50% of pediatric patients with bacteremia.

OBJECTIVES

To analyze clinical and epidemiologic variables associated with Gram-negative bacteremia in a tertiary children's medical center.

METHODS

A 6-year prospective study of children with Gram-negative bacteremia in a tertiary care children's medical center in Israel.

RESULTS

Three hundred seventy-four episodes of Gram-negative bacteremia were studied during 6 years. The predominant isolates were Klebsiella pneumoniae, Pseudomonas aeruginosa and Escherichia coli, which accounted for 109, 81 and 79 episodes (26, 20 and 19%), respectively. Of all episodes 43% occurred in neonates and infants younger than 2 years and 47% were hospital-acquired. Underlying conditions mainly acute leukemia and lymphoma, were present in 55% of the patients. Urinary tract infection followed by lower respiratory tract infection were the most common identified sources of bacteremia. Central intravenous catheters were associated with 53% of the episodes. The crude mortality was 11.4%. Increased mortality was significantly associated with acute leukemia, neutropenia, hospital-acquired infections and previous corticosteroid therapy (P = 0.03, 0.003, 0.006 and 0.01, respectively). Increased antibiotic resistance of hospital-acquired vs community-acquired isolates was noted; 44 to 77% resistance of nosocomial Klebsiella and Enterobacter sp. to second and third generation cephalosporins and 18% were resistant to amikacin.

CONCLUSIONS

Klebsiella pneumoniae is currently the most common organism causing Gram-negative bacteremia in children. Because of the relatively high resistance of Gram-negative organisms to second and third generation cephalosporins, we suggest that empiric antibiotic therapy for Gram-negative bacteremia include a combination of an aminoglycoside and an anti-Pseudomonas beta-lactam.

摘要

背景

医院获得性和社区获得性革兰阴性菌血症是儿科医疗中心死亡和发病的重要原因。革兰阴性菌在超过50%的菌血症儿科患者中被分离出来。

目的

分析一家三级儿童医疗中心与革兰阴性菌血症相关的临床和流行病学变量。

方法

对以色列一家三级医疗儿童医疗中心的革兰阴性菌血症患儿进行为期6年的前瞻性研究。

结果

6年间共研究了374例革兰阴性菌血症发作。主要分离菌株为肺炎克雷伯菌、铜绿假单胞菌和大肠埃希菌，分别占109例、81例和79例（26%、20%和19%）。所有发作中，43%发生在2岁以下的新生儿和婴儿，47%为医院获得性。55%的患者存在基础疾病，主要是急性白血病和淋巴瘤。尿路感染继以下呼吸道感染是最常见的菌血症确诊来源。中心静脉导管与53%的发作相关。粗死亡率为11.4%。死亡率增加与急性白血病、中性粒细胞减少、医院获得性感染和先前的皮质类固醇治疗显著相关（分别为P = 0.03、0.003、0.006和0.01）。注意到医院获得性分离株与社区获得性分离株相比抗生素耐药性增加；医院内肺炎克雷伯菌和肠杆菌属对第二代和第三代头孢菌素的耐药率为44%至77%，对阿米卡星的耐药率为18%。