Bloodstream infections in pediatric ECLS: usefulness of daily blood culture monitoring and predictive value of biological markers. The British Columbia experience
| Autor: | Simon Dobson, Edith Blondel-Hill, Gregor W. Kaczala, Stéphane Paulus, Avash J. Singh, Nawaf Al-Dajani, Arthur Cogswell, Wilson Jang |
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| Rok vydání: | 2009 |
| Předmět: |
Male
Microbiological Techniques medicine.medical_specialty Extracorporeal Circulation Adolescent Extracorporeal Sepsis Predictive Value of Tests Bloodstream infection Pediatric surgery medicine Humans Blood culture Intensive care medicine Retrospective Studies medicine.diagnostic_test business.industry Incidence (epidemiology) Infant Newborn Infant General Medicine medicine.disease Predictive value Blood Life support Child Preschool Pediatrics Perinatology and Child Health Emergency medicine Surgery Female business Biomarkers |
| Zdroj: | Kaczala, Gregor W; Paulus, Stephane C; Al-Dajani, Nawaf; Jang, Wilson; Blondel-Hill, Edith; Dobson, Simon; Cogswell, Arthur; Singh, Avash J (2009). Bloodstream infections in pediatric ECLS: usefulness of daily blood culture monitoring and predictive value of biological markers. The British Columbia experience. Pediatric surgery international, 25(2), pp. 169-73. Berlin: Springer 10.1007/s00383-008-2299-1 |
| DOI: | 10.48350/27208 |
| Popis: | INTRODUCTION: The incidence of bloodstream infection (BSI) in extracorporeal life support (ECLS) is reported between 0.9 and 19.5%. In January 2006, the Extracorporeal Life Support Organization (ELSO) reported an overall incidence of 8.78% distributed as follows: respiratory: 6.5% (neonatal), 20.8% (pediatric); cardiac: 8.2% (neonatal) and 12.6% (pediatric). METHOD: At BC Children's Hospital (BCCH) daily surveillance blood cultures (BC) are performed and antibiotic prophylaxis is not routinely recommended. Positive BC (BC+) were reviewed, including resistance profiles, collection time of BC+, time to positivity and mortality. White blood cell count, absolute neutrophile count, immature/total ratio, platelet count, fibrinogen and lactate were analyzed 48, 24 and 0 h prior to BSI. A univariate linear regression analysis was performed. RESULTS: From 1999 to 2005, 89 patients underwent ECLS. After exclusion, 84 patients were reviewed. The attack rate was 22.6% (19 BSI) and 13.1% after exclusion of coagulase-negative staphylococci (n = 8). BSI patients were significantly longer on ECLS (157 h) compared to the no-BSI group (127 h, 95% CI: 106-148). Six BSI patients died on ECLS (35%; 4 congenital diaphragmatic hernias, 1 hypoplastic left heart syndrome and 1 after a tetralogy repair). BCCH survival on ECLS was 71 and 58% at discharge, which is comparable to previous reports. No patient died primarily because of BSI. No BSI predictor was identified, although lactate may show a decreasing trend before BSI (P = 0.102). CONCLUSION: Compared with ELSO, the studied BSI incidence was higher with a comparable mortality. We speculate that our BSI rate is explained by underreporting of "contaminants" in the literature, the use of broad-spectrum antibiotic prophylaxis and a higher yield with daily monitoring BC. We support daily surveillance blood cultures as an alternative to antibiotic prophylaxis in the management of patients on ECLS. |
| Databáze: | OpenAIRE |
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