儿童MRSA血流感染血培养随访及持续感染临床预警因素分析

Analysis of follow-up blood culture in children with MRSA bloodstream infection and clinical early warning factors of persistent infection

目的探讨儿童耐甲氧西林金黄色葡萄球菌(MRSA)血流感染的血培养随访情况及持续感染预警因素。方法回顾性收集2016年1月至2021年12月该院收治的MRSA血流感染患儿临床资料。多因素logistic回归模型分析MRSA持续血流感染(感染持续时间大于或等于2 d)可能预警因素。结果共纳入72例MRSA血流感染住院患儿,51例(70.83%)患儿完成血培养随访,18例(35.29%)在指南推荐时间内完成。首次血培养阳性2 d后随访患儿中,19例(38.00%)为持续感染。多因素logistic回归分析显示,社区获得性血流感染(OR=8.50,95%CI:1.30~55.80,P=0.03)、白细胞计数(WBC)>17.92×10^(9)/L(OR=13.28,95%CI:1.55~113.60,P=0.02)和不恰当经验性抗菌药物治疗(OR=8.15,95%CI:1.49~44.55,P=0.02)可能是MRSA持续血流感染的预警因素。结论分析儿童MRSA血流感染血培养随访及持续感染临床预警因素,可为合理诊治儿童MRSA血流感染提供了一定参考依据。

Objective To explore follow-up blood culture in children with methicillin-resistant staphylococcus aureus(MRSA)bloodstream infection and the early warning factors of persistent infection.Methods The clinical data of children with MRSA bloodstream infection admitted to the hospital from January 2016 to December 2021 were collected retrospectively.Multivariate logistic regression analysis was used to analyze the possible early warning factors of persistent MRSA bloodstream infection,which was defined as bloodstream infection lasting≥2 days.Results A total of 72 hospitalized children with MRSA bloodstream infection were enrolled,of which 51 patients(70.83%)completed follow-up blood culture,and 18 patients(35.29%)carried out within the time window recommended by guideline.Among the children who completed follow-up blood culture after two days of the initial positive blood culture,19 patients(38.00%)had persistent bloodstream infection.Multivariate logistic regression analysis showed that community-acquired bloodstream infection(OR=8.50,95%CI:1.30-55.80,P=0.03),and white blood cell(WBC)>17.92×10^(9)/L(OR=13.28,95%CI:1.55-113.60,P=0.02)and inappropriate antibiotic therapy(OR=8.15,95%CI:1.49-44.55,P=0.02)may be the early warning factors of persistent MRSA bloodstream infection.Conclusion The analysis of the follow-up blood culture in children with MRSA bloodstream infection and the clinical early warning factor of persistent infection can provide some rational reference for diagnosis and treatment of MRSA bloodstream infection in children.