Risk factors for prolonged infection and secondary infection in pediatric severe sepsis.

IF 5.4 2区医学 Q1 INFECTIOUS DISEASES

Infection Pub Date : 2024-08-08 DOI:10.1007/s15010-024-02355-1

Zachary Aldewereld, Brendan Connolly, Russell K Banks, Ron Reeder, Richard Holubkov, Robert A Berg, David Wessel, Murray M Pollack, Kathleen Meert, Mark Hall, Christopher Newth, John C Lin, Allan Doctor, Tim Cornell, Rick E Harrison, Athena F Zuppa, J Michael Dean, Joseph A Carcillo

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引用次数: 0

Abstract

Purpose: Sepsis causes significant worldwide morbidity and mortality. Inability to clear an infection and secondary infections are known complications in severe sepsis and likely result in worsened outcomes. We sought to characterize risk factors of these complications.

Methods: We performed a secondary analysis of clinical data from 401 subjects enrolled in the PHENOtyping sepsis-induced Multiple organ failure Study. We examined factors associated with prolonged infection, defined as infection that continued to be identified 7 days or more from initial identification, and secondary infection, defined as new infections identified ≥ 3 days from presentation. Multivariable adjustment was performed to examine laboratory markers of immune depression, with immunocompromised and immunocompetent subjects analyzed separately.

Results: Illness severity, immunocompromised status, invasive procedures, and site of infection were associated with secondary infection and/or prolonged infection. Persistent lymphopenia, defined as an absolute lymphocyte count (ALC) < 1000 cells/µL twice in the first five days, and persistent neutropenia, defined as absolute neutrophil count (ANC) < 1000 cells/µL twice in the first five days, were associated with secondary and prolonged infections. When adjusted in multivariable analysis, persistent lymphopenia remained associated with secondary infection in both immunocompromised (aOR = 14.19, 95% CI [2.69, 262.22] and immunocompetent subjects (aOR = 2.09, 95% CI [1.03, 4.17]). Persistent neutropenia was independently associated with secondary infection in immunocompromised subjects (aOR = 5.34, 95% CI [1.92, 15.84]). Secondary and prolonged infections were associated with worse outcomes, including death.

Conclusions: Laboratory markers of immune suppression can be used to predict secondary infection. Lymphopenia is an independent risk factor in immunocompromised and immunocompetent patients for secondary infection.

Abstract Image

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小儿严重败血症中长期感染和继发感染的风险因素。

目的：败血症在全球范围内造成严重的发病率和死亡率。无法清除感染和继发感染是重症脓毒症的已知并发症，可能导致预后恶化。我们试图找出这些并发症的风险因素：我们对参加 PHENOtyping 败血症诱发多器官功能衰竭研究的 401 名受试者的临床数据进行了二次分析。我们研究了与长期感染（定义为自初次发现感染起 7 天或更长时间内持续发现的感染）和继发性感染（定义为自发病起≥ 3 天发现的新感染）相关的因素。对免疫功能低下和免疫功能正常的受试者分别进行了多变量调整，以检查免疫功能低下的实验室指标：结果：病情严重程度、免疫功能低下状况、侵入性手术和感染部位与继发感染和/或感染时间延长有关。持续性淋巴细胞减少症是指绝对淋巴细胞计数（ALC）免疫抑制的实验室指标可用于预测继发感染。淋巴细胞减少症是免疫功能低下和免疫功能正常患者继发感染的独立风险因素。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Infection 医学-传染病学

CiteScore

12.50

自引率

1.30%

发文量

224

审稿时长

6-12 weeks

期刊介绍： Infection is a journal dedicated to serving as a global forum for the presentation and discussion of clinically relevant information on infectious diseases. Its primary goal is to engage readers and contributors from various regions around the world in the exchange of knowledge about the etiology, pathogenesis, diagnosis, and treatment of infectious diseases, both in outpatient and inpatient settings. The journal covers a wide range of topics, including: Etiology: The study of the causes of infectious diseases. Pathogenesis: The process by which an infectious agent causes disease. Diagnosis: The methods and techniques used to identify infectious diseases. Treatment: The medical interventions and strategies employed to treat infectious diseases. Public Health: Issues of local, regional, or international significance related to infectious diseases, including prevention, control, and management strategies. Hospital Epidemiology: The study of the spread of infectious diseases within healthcare settings and the measures to prevent nosocomial infections. In addition to these, Infection also includes a specialized "Images" section, which focuses on high-quality visual content, such as images, photographs, and microscopic slides, accompanied by brief abstracts. This section is designed to highlight the clinical and diagnostic value of visual aids in the field of infectious diseases, as many conditions present with characteristic clinical signs that can be diagnosed through inspection, and imaging and microscopy are crucial for accurate diagnosis. The journal's comprehensive approach ensures that it remains a valuable resource for healthcare professionals and researchers in the field of infectious diseases.