Durongpisitkul K, Gururaj V J, Martin C F
Department of Pediatrics, Texas Tech University Health Sciences Center, Lubbock 79430, USA.
J Fam Pract. 1997 Jan;44(1):91-6.
Febrile children with suspected sepsis are often hospitalized and empirically treated with parenteral antibiotics pending results of bacterial cultures. The question of just how long such children should be observed and treated following initial negative culture reports has not been adequately addressed. This study was designed to determine the appropriateness of discharging hospitalized culture-negative children with suspected sepsis at the end of 48 hours.
All children admitted with a diagnosis of "suspected sepsis" over an 8-month period were prospectively evaluated. Based on initial culture data, children were divided into two groups: group A with positive bacterial cultures and group B with negative bacterial cultures. Clinical assessment and review of cerebrospinal fluid, blood, and urine culture data were made at 24 hours, 48 hours, and until discharge, and at 2 weeks following discharge of all group B patients.
Of the 83 children enrolled in the study, 8 (9.5%) patients had a culture positive for bacterial infection (group A): meningitis in two, bacteremia in six, and urinary tract infection in two. All cultures were positive within 48 hours. Cultures were negative at 48 hours in the remaining 75 (90.4%) children (group B), and remained negative until discharge and at 2-week follow-up. Eight (10.6%) patients had received antibiotics prior to admission. After the workup, 37 of 73 (50.6%) children received antibiotics for less than 48 hours, while 36 (49.4%) children did so for more than 48 hours. Clinical assessment was normal at 48 hours in 71 of the 75 children. Sixty-three (84%) children available for follow-up continued to do well after discharge. No statistical distinction could be made between those children who remained hospitalized after 48 hours and those children who were dismissed at 48 hours.
Although our study data suggest that culture-negative children hospitalized for suspected sepsis who meet the criteria for normal clinical assessment can be safely discharged at 48 hours, a stronger statistical validation of this approach can be made if a larger sample size is studied.
疑似脓毒症的发热儿童通常会住院治疗，并在细菌培养结果出来之前经验性地使用肠胃外抗生素进行治疗。对于此类儿童在初次培养报告为阴性后应观察和治疗多长时间的问题，尚未得到充分解决。本研究旨在确定在48小时结束时让疑似脓毒症但培养结果为阴性的住院儿童出院是否合适。
对在8个月期间诊断为“疑似脓毒症”而入院的所有儿童进行前瞻性评估。根据初始培养数据，将儿童分为两组：A组细菌培养结果为阳性，B组细菌培养结果为阴性。在24小时、48小时、直至出院时以及所有B组患者出院后2周时，对脑脊液、血液和尿液培养数据进行临床评估和复查。
在纳入研究的83名儿童中，8名（9.5%）患者细菌感染培养结果为阳性（A组）：2例为脑膜炎，6例为菌血症，2例为尿路感染。所有培养结果均在48小时内呈阳性。其余75名（90.4%）儿童（B组）在48小时时培养结果为阴性，直至出院及2周随访时仍为阴性。8名（10.6%）患者在入院前接受过抗生素治疗。检查后，73名儿童中的37名（50.6%）接受抗生素治疗少于48小时，而36名（49.4%）儿童接受抗生素治疗超过48小时。75名儿童中的71名在48小时时临床评估正常。63名（84%）可供随访的儿童出院后情况持续良好。在48小时后仍住院的儿童与在48小时时出院的儿童之间无法进行统计学区分。
尽管我们的研究数据表明，因疑似脓毒症住院且临床评估符合正常标准的培养结果为阴性的儿童在48小时时可以安全出院，但如果研究更大的样本量，这种方法可以得到更强有力的统计学验证。
