[儿科患者的医疗相关感染：在重症监护病房的十年经验]。

IF 0.8 4区医学 Q3 MEDICINE, GENERAL & INTERNAL

Acta medica portuguesa Pub Date : 2025-01-02 DOI:10.20344/amp.22279

Cátia Martins, Daniela Lima, Mariana Cortez Ferreira, Joana Verdelho Andrade, Andrea Dias

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引用次数: 0

摘要

导读：医疗保健相关感染是儿童发病率和死亡率的重要原因，也是重症监护服务中日益严重的问题。然而，关于葡萄牙儿科人群中这些感染的数据有限。本研究旨在估计其在葡萄牙儿科重症监护病房的患病率，确定最常见的微生物及其抗生素耐药性概况。方法：采用回顾性队列研究，纳入2014年1月1日至2023年12月31日期间入住儿科重症监护病房并在住院期间诊断为医疗保健相关感染的患者。结果：共发现医院感染248例，患病率为6.3%，以婴幼儿为主。肺炎（45.2%）和菌血症（14.5%）是最常见的感染。革兰氏阴性菌，特别是大肠杆菌、铜绿假单胞菌和肺炎克雷伯菌是最常见的致病菌。在过去五年中（2019 - 2023年），全球抗生素耐药性有所增加。2019年至2023年期间，产esbl细菌、MRSA和ERC的感染率分别为8.5%、1.6%和0.4%。在97项筛选试验中，41例患者中鉴定出45个定植：40例为ESBL， 5例为ERC，未检测到MRSA定植。脓毒症发生率为29.8%，死亡率为11.7%，其中4.0%直接归因于医疗保健相关感染。肺炎的危险因素包括暴露于气管内插管和长时间有创通气(OR = 2.5；95% CI, 1.1 ~ 5.9, p = 0.03；and OR = 1.9；95% CI, 1.1 ~ 3.4, p = 0.011；分别)。结论：实施有效的耐药菌防治策略对保障现有治疗、提高患者安全和保护公众健康至关重要。

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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[Healthcare-Associated Infections in Pediatric Patients: A Decade of Experience in an Intensive Care Unit].

Introduction: Healthcare-associated infections are an important cause of morbidity and mortality in the pediatric population and a growing problem in intensive care services. However, limited data are available on these infections in the Portuguese pediatric population. This study aimed to estimate its prevalence rate in a Portuguese pediatric intensive care unit, identifying the most frequent microorganisms and their antibiotic resistance profiles.

Methods: A retrospective cohort study was conducted, including patients admitted to a pediatric intensive care unit between January 1, 2014 and December 31, 2023, who were diagnosed with healthcare-associated infections during hospitalization.

Results: A total of 248 nosocomial infections were identified, corresponding to a prevalence rate of 6.3%, mostly in infants. Pneumonia (45.2%) and bacteremia (14.5%) were the most frequent infections. Gram-negative bacteria, specifically Escherichia coli, Pseudomonas aeruginosa and Klebsiella pneumoniae, were the most common pathogens. Over the last five years (2019 - 2023), there was a global increase in antibiotic resistance. The prevalence of infections with ESBL-producing bacteria, MRSA and ERC was 8.5%, 1.6%, and 0.4%, respectively, higher in the period from 2019 to 2023. Among 97 screening tests, 45 colonizations were identified in 41 patients: 40 with ESBL and 5 with ERC, with no MRSA colonizations detected. Sepsis occurred in 29.8% of cases, and the mortality rate was 11.7%, with 4.0% directly attributed to healthcare-associated infections. Risk factors for pneumonia included exposure to endotracheal tubes and prolonged invasive ventilation (OR = 2.5; 95% CI, 1.1 to 5.9, p = 0.03; and OR = 1.9; 95% CI, 1.1 to 3.4, p = 0.011; respectively).

Conclusion: Implementing effective strategies to prevent and control resistant bacteria is essential to safeguard current therapies, enhance patient safety, and protect public health.

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来源期刊

Acta medica portuguesa MEDICINE, GENERAL & INTERNAL-

CiteScore

1.90

自引率

16.70%

发文量

256

审稿时长

6-12 weeks

期刊介绍： The aim of Acta Médica Portuguesa is to publish original research and review articles in biomedical areas of the highest standard, covering several domains of medical knowledge, with the purpose to help doctors improve medical care. In order to accomplish these aims, Acta Médica Portuguesa publishes original articles, review articles, case reports and editorials, among others, with a focus on clinical, scientific, social, political and economic factors affecting health. Acta Médica Portuguesa will be happy to consider manuscripts for publication from authors anywhere in the world.