PDF(Pubmed)
Abstract：
UNASSIGNED: Health care-associated primary bloodstream infections (BSIs), defined as not secondary to an infection at another body site, including central line-associated BSI, are a leading cause of morbidity and mortality in patients in neonatal intensive care units (NICUs). Our objective was to identify factors associated with severe morbidity and mortality after these infections in neonates in NICUs.
UNASSIGNED: This ancillary study of the SEPREVEN trial included neonates hospitalized ≥2 days in one of 12 French NICUs and with ≥ 1 BSI during the 20-month study period. BSIs (all primary and health care-associated) were diagnosed in infants with symptoms suggestive of infection and classified prospectively as possible (one coagulase-negative staphylococci (CoNS)-growing blood culture) or proven (two same CoNS, or ≥1 recognized pathogen-growing blood culture). BSI consequences were collected prospectively as moderate morbidity (antibiotic treatment alone) or severe morbidity/mortality (life-saving procedure, permanent damage, prolonged hospitalization, and/or death).
UNASSIGNED: Of 557 BSIs identified in 494 patients, CoNS accounted for 378/557 (67.8%) and recognized bacterial or fungal pathogens for 179/557 (32.1%). Severe morbidity/mortality was reported in 148/557 (26.6%) BSIs. Independent factors associated with severe morbidity/mortality were corrected gestational age <28 weeks (CGA) at infection (P < .01), fetal growth restriction (FGR) (P = .04), and proven pathogen-related BSI vs. CoNS-related BSI (P < .01). There were no differences in severe morbidity and mortality between proven and possible CoNS BSIs. In possible BSI, S. epidermidis was associated with a lower risk of severe morbidity than other CoNS (P < .01), notably S. capitis and S. haemolyticus.
UNASSIGNED: In BSIs in the NICU, severe morbidity/mortality was associated with low CGA at infection, FGR, and proven pathogen-related BSIs. When only one blood culture was positive, severe morbidity/mortality were less frequent if it grew with S. epidermidis compared to other CoNS. Further studies to help distinguish real CoNS BSIs from contaminations are needed.
UNASSIGNED: ClinicalTrials.gov (NCT02598609).
UNASSIGNED: This ancillary study of the SEPREVEN trial included neonates hospitalized ≥2 days in one of 12 French NICUs and with ≥ 1 BSI during the 20-month study period. BSIs (all primary and health care-associated) were diagnosed in infants with symptoms suggestive of infection and classified prospectively as possible (one coagulase-negative staphylococci (CoNS)-growing blood culture) or proven (two same CoNS, or ≥1 recognized pathogen-growing blood culture). BSI consequences were collected prospectively as moderate morbidity (antibiotic treatment alone) or severe morbidity/mortality (life-saving procedure, permanent damage, prolonged hospitalization, and/or death).
UNASSIGNED: Of 557 BSIs identified in 494 patients, CoNS accounted for 378/557 (67.8%) and recognized bacterial or fungal pathogens for 179/557 (32.1%). Severe morbidity/mortality was reported in 148/557 (26.6%) BSIs. Independent factors associated with severe morbidity/mortality were corrected gestational age <28 weeks (CGA) at infection (P < .01), fetal growth restriction (FGR) (P = .04), and proven pathogen-related BSI vs. CoNS-related BSI (P < .01). There were no differences in severe morbidity and mortality between proven and possible CoNS BSIs. In possible BSI, S. epidermidis was associated with a lower risk of severe morbidity than other CoNS (P < .01), notably S. capitis and S. haemolyticus.
UNASSIGNED: In BSIs in the NICU, severe morbidity/mortality was associated with low CGA at infection, FGR, and proven pathogen-related BSIs. When only one blood culture was positive, severe morbidity/mortality were less frequent if it grew with S. epidermidis compared to other CoNS. Further studies to help distinguish real CoNS BSIs from contaminations are needed.
UNASSIGNED: ClinicalTrials.gov (NCT02598609).
摘要：
■医疗保健相关的原发性血流感染（BSI），定义为不是继发于另一个身体部位的感染，包括中心线相关的BSI，是新生儿重症监护病房（NICU）患者发病和死亡的主要原因。我们的目标是确定NICU新生儿感染后与严重发病率和死亡率相关的因素。
■这项SEPREVEN试验的辅助研究包括在20个月的研究期间，在12个法国NICU中住院≥2天并且BSI≥1的新生儿。BSI（所有初级和医疗保健相关）在有感染症状的婴儿中被诊断出来，并尽可能进行前瞻性分类（一种凝固酶阴性葡萄球菌（CoNS）-生长的血培养）或证实（两种相同的CoNS，或≥1个公认的病原体生长血培养物)。BSI后果被前瞻性地收集为中度发病率(单独的抗生素治疗)或重度发病率/死亡率(救生程序,永久性损伤,住院时间延长,和/或死亡）。
■在494名患者中确定的557个BSI中，CoNS占378/557（67.8％），公认的细菌或真菌病原体占179/557（32.1％）。148/557（26.6%）BSI报告了严重的发病率/死亡率。与严重发病率/死亡率相关的独立因素是感染时校正胎龄<28周（CGA）（P<0.01），胎儿生长受限（FGR）（P=.04），和证明与病原体相关的BSIvs.CoNS相关的BSI（P<0.01）。已证实和可能的CoNSBSIs之间的严重发病率和死亡率没有差异。在可能的BSI中，与其他CoNS相比，表皮葡萄球菌的严重发病率风险较低（P<0.01），特别是S.capitis和溶血链球菌。
■在NICU的BSI中，严重的发病率/死亡率与感染时的低CGA相关，FGR,和已证明与病原体相关的BSI。当只有一个血培养阳性时，与其他CoNS相比,与表皮葡萄球菌一起增长的严重发病率/死亡率较低.需要进一步的研究来帮助区分真实的CoNSBSI与污染物。
■ClinicalTrials.gov（NCT02598609）。
■这项SEPREVEN试验的辅助研究包括在20个月的研究期间，在12个法国NICU中住院≥2天并且BSI≥1的新生儿。BSI（所有初级和医疗保健相关）在有感染症状的婴儿中被诊断出来，并尽可能进行前瞻性分类（一种凝固酶阴性葡萄球菌（CoNS）-生长的血培养）或证实（两种相同的CoNS，或≥1个公认的病原体生长血培养物)。BSI后果被前瞻性地收集为中度发病率(单独的抗生素治疗)或重度发病率/死亡率(救生程序,永久性损伤,住院时间延长,和/或死亡）。
■在494名患者中确定的557个BSI中，CoNS占378/557（67.8％），公认的细菌或真菌病原体占179/557（32.1％）。148/557（26.6%）BSI报告了严重的发病率/死亡率。与严重发病率/死亡率相关的独立因素是感染时校正胎龄<28周（CGA）（P<0.01），胎儿生长受限（FGR）（P=.04），和证明与病原体相关的BSIvs.CoNS相关的BSI（P<0.01）。已证实和可能的CoNSBSIs之间的严重发病率和死亡率没有差异。在可能的BSI中，与其他CoNS相比，表皮葡萄球菌的严重发病率风险较低（P<0.01），特别是S.capitis和溶血链球菌。
■在NICU的BSI中，严重的发病率/死亡率与感染时的低CGA相关，FGR,和已证明与病原体相关的BSI。当只有一个血培养阳性时，与其他CoNS相比,与表皮葡萄球菌一起增长的严重发病率/死亡率较低.需要进一步的研究来帮助区分真实的CoNSBSI与污染物。
■ClinicalTrials.gov（NCT02598609）。
