Objective: To investigate the pathogen composition, initial anti-infectives and pathogen coverage, and trends over the last 5 years in children with septic shock in pediatric intensive care unit (PICU). Methods: The single-center retrospective study included 257 children with septic shock who were admitted to PICU of Beijing Children's Hospital, Capital Medical University from 2017 to 2021. The causitive pathogen composition, initial use of anti-infective drugs, pathogen coverage, and changes in recent years were analyzed. The children were divided into sufficient and insufficient coverage groups according to whether the pathogen were sufficiently covered by initial anti-infectives; community-and hospital-acquired groups; and with and without underlying disease groups. T test, rank-sum test and Chi-square test were used for comparison between the groups to investigate the differences in pathogen, treatment and prognosis. Results: A total of 257 septic shock children were included, with 162 males and 95 females, aged 36 (12, 117) months. The pathogen positive rate was 64.6% (166/257) and the in-hospital mortality was 27.6% (71/257). In the 208 pathogen-positive samples, bacteria was the most common (57.7%, 120/208) with G-negative bacteria predominating (55.8%, 67/120), followed by viruses (26.0%, 54/208). Nearly 99.2% (255/257) of the children were treated with antibacterial at the beginning, of whom 47.1% (121/257) were treated with carbapenems combined with vancomycin or linezolid. The proportion of 3 or more antibacterial combinations was higher in children with underlying diseases and hospital-acquired septic shock than in those without underlying disease or community-acquired septic shock (27.4% (49/179) vs. 14.1% (11/78), 29.4% (52/177) vs. 10.0% (8/80), χ2=5.35,11.56,all P<0.05). The proportion of initial combination of carbapenem and vancomycin or linezolid reduced from 52.5% (21/40) to 41.3% (19/46), and of adequate pathogen coverage increased from 40.0% (16/40) to 58.7% (27/46) in the last five years. Conclusions: The initial use of antibacterial drugs is common in children with septic shock in PICU, especially in those with hospital-acquired septic shock and underlying diseases. In recent years, antimicrobial combinations have decreased, but the pathogen coverage has improved, indicating that drug selection is more reasonable and accurate.
目的: 了解儿童重症监护病房(PICU)脓毒性休克患儿初始抗感染药物使用、病原覆盖性和近5年变化趋势。 方法: 回顾性分析北京儿童医院PICU 2017至2021年收治的257例脓毒性休克患儿的一般情况、致病病原、初始抗感染药物使用、病原覆盖及近5年变化趋势。据初始抗感染病原覆盖性分为覆盖充分和不充分2组,据脓毒性休克发病时间分为社区获得性和院内获得性2组,据是否合并基础病分为有基础疾病、无基础疾病2组。采用t检验、秩和检验、χ2检验比较组间病原学、治疗及住院病死率差异。 结果: 257例患儿中男162例、女95例,年龄36(12,117)月龄。病原阳性率64.6%(166/257),住院病死率27.6%(71/257)。共检出阳性病原样本208份,细菌最多(57.7%,120/208),以革兰阴性杆菌为主(55.8%,67/120);病毒次之(26.0%,54/208)。99.2%(255/257)的患儿初始抗感染使用了抗菌药物,47.1%(121/257)使用了碳青霉烯+万古霉素或利奈唑胺。合并基础疾病和院内获得性脓毒性休克患儿3种及以上抗细菌药物联用比例分别高于无基础疾病和社区获得性休克组患儿[27.4%(49/179)比14.1%(11/78),29.4%(52/177)比10.0%(8/80),χ2=5.35、11.56,均P<0.05]。近5年初始抗感染药物使用(碳青霉烯+万古霉素)/利奈唑胺由52.5%(21/40)降至41.3%(19/46)、病原覆盖充分比例由40.0%(16/40)提高至58.7 %(27/46)。 结论: PICU脓毒性休克患儿初始抗感染抗细菌药物使用比例高,院内获得性和存在基础疾病患儿使用种类多。近年抗细菌药物联用有减少趋势,但病原覆盖充分性提高,选药更趋合理和精准。.