Objective: To summarize the pathogenic characteristics of bloodstream infection (BSI)-induced severe sepsis and analyze the influence factors in pediatric intensive care unit (PICU). Methods: Pediatric patients who were diagnosed with severe sepsis caused by BSI in the PICU of Children's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 2016 to December 2021 were retrospectively selected and divided into survival group and death group according to their discharge outcomes. Clinical characteristics, laboratory parameters, pathogenic characteristics and drug resistance of the patients were collected. The characteristics of pathogens, clinical and laboratory indicators were summarized, and the influencing factors of death in children with severe sepsis caused by BSI were analyzed based on binary multivariate logistic regression. Results: A total of 132 patients, aged [M (Q1, Q3)] 36 (10, 119) months, with BSI-induced severe sepsis were enrolled in this study, including 81 males and 51 females. There were 38 cases aged 36 (15, 120) months in the death group, including 23 males and 15 females. There were 94 cases, aged 36 (8, 108) months, in the survival group, including 58 males and 36 females. A total of 132 strains of pathogens were isolated, including 87 strains (65.9%) of Gram-negative bacteria. The top 5 pathogens were Klebsiella pneumoniae (24 cases, 18.2%), Escherichia coli (17 cases, 12.9%), Acinetobacter baumannii (13 cases, 9.8%), Pseudomonas aeruginosa (10 cases, 7.6%) and Staphylococcus aureus (10 cases, 7.6%). The proportion of multi-drug resistant bacteria in hospital-acquired BSI was higher than that in community-acquired BSI [52.9% (36/68) vs 15.6% (10/64), P=0.001]. The proportions of community-acquired infection were 58.5% (55/94) and 23.7% (9/38) in the survival and death groups, respectively, the difference was statistically significant (P<0.001). The proportion of central venous catheter insertion before bloodstream infection in the death group was higher than that in the survival group [63.2% (24/38) vs 42.6% (40/94), P=0.034]. According to the binary multivariate logistic regression analysis, hospital-acquired infection (OR=4.80, 95%CI: 1.825-12.621, P=0.001), absolute neutrophil count (ANC) (OR=0.93, 95%CI: 0.863-0.993, P=0.030) and decreased albumin (OR=0.89, 95%CI: 0.817-0.977, P=0.014) were risk factors for death. Conclusions: The common pathogen of BSI-induced severe sepsis in PICU is Gram-negative bacteria. The proportion of multi-drug resistant organisms of BSI obtained in hospitals is high. Children with severe sepsis due to BSI with nosocomial acquired infection, ANC and decreased albumin have a high risk of death.
目的： 总结儿童重症监护病房（PICU）血流感染（BSI）严重脓毒症的病原学特点，分析死亡的影响因素。 方法： 回顾性选择2016年1月至2021年12月上海交通大学医学院附属儿童医院PICU收治的BSI严重脓毒症患儿，根据患儿出院转归情况分为存活组和死亡组。收集患儿的临床资料、实验室指标以及病原菌特点与耐药情况。总结病原菌、临床与实验室指标特征，基于二元多因素logistic回归分析BSI严重脓毒症患儿死亡的影响因素。 结果： 共纳入BSI严重脓毒症患儿132例，男81例，女51例，年龄［M（Q1，Q3）］为36（10，119）个月，其中死亡组38例［男23例，女15例，年龄36（15，120）个月］，存活组94例［男58例，女36例，年龄36（8，108）个月］。共分离出病原菌132株，革兰阴性菌87株（65.9%），占比前5位的病原菌依次为肺炎克雷伯菌24例（18.2%）、大肠埃希菌17例（12.9%）、鲍曼不动杆菌13例（9.8%）、铜绿假单胞菌10例（7.6%）、金黄色葡萄球菌10例（7.6%）。医院内获得性BSI多重耐药菌比例高于社区获得性BSI［52.9%（36/68）比15.6%（10/64），P=0.001］。存活组与死亡组患儿中社区获得性感染率分别为58.5%（55/94）和23.7%（9/38），差异有统计学意义（P<0.001）。死亡组患儿发生BSI前中心静脉导管置入比例高于存活组［63.2%（24/38）比42.6%（40/94），P=0.034］。二元多因素logistic回归分析显示，医院内获得性感染（OR=4.80，95%CI：1.825~12.621，P=0.001）、中性粒细胞绝对值（ANC）（OR=0.93，95%CI：0.863~0.993，P=0.030）和白蛋白降低（OR=0.89，95%CI：0.817~0.977，P=0.014）是死亡的危险因素。 结论： BSI严重脓毒症的主要病原菌为革兰阴性菌，医院内获得BSI多重耐药菌比例高；医院内获得性感染、ANC和白蛋白降低的BSI严重脓毒症患儿死亡风险高。.