Epidemiologia e etiologia da sepse na infância

Abstract

Objective

To establish an etiological and epidemiological profile of sepsis among children hospitalized in the Hospital Infantil Albert Sabin - HIAS, a referred care public hospital for all pediatric diseases in the state of Ceará, Brazil, since this disease has shown high prevalence and considerable mortality in this hospital. Methods: We conducted a prospective study of all children admitted to the hospital from January 1993 to June 1994 and who presented with sepsis or developed nosocomial sepsis with positive blood culture results. We used questionnaires to collect information about: sex, age, reference area, nutritional status, complaints at admission, sepsis origin (nosocomial or not), and outcome for each case. Microbiologic analysis of the isolated bacteria was performed by blood culture, together with tests of sensitivity to the most commonly used antibiotics. All tests were performed at the Microbiology Laboratory at the Health Sciences Center of the Federal University, Ceará, Brazil. Results: Of the 205 children studied, 17 presented two septic episodes, totaling 222 episodes in the period. Of all the children, 56.1% were boys, 81.4% were younger than 1 year old, 71.1% were malnourished, and 60.5% came from the countryside in Ceará. At admission, 2/3 presented with gastrointestinal problems (diarrhea) or respiratory complaints, whereas 47.7% of the episodes of sepsis were acquired in the hospital. Mortality rate was 56.1%. Blood culture results showed a predominance of the following bacteria: Staphylococcus aureus (24.8%), Klebsiella pneumoniae (22.6%), Pseudomonas aeruginosa (15.2%), Enterobacter sp (11.2%), Escherichia coli (7%), and others (19.2%). Conclusions: The epidemiological profile of the population in this study was the following: children were younger than 1 year, most of them were malnourished and presented with diarrhea or respiratory disease at admission; 40% had a disease or condition that favored the development of sepsis. The predominant bacteria were Staphylococcus aureus and Klebsiella pneumoniae.

Methods

We conducted a prospective study of all children admitted to the hospital from January 1993 to June 1994 and who presented with sepsis or developed nosocomial sepsis with positive blood culture results. We used questionnaires to collect information about: sex, age, reference area, nutritional status, complaints at admission, sepsis origin (nosocomial or not), and outcome for each case. Microbiologic analysis of the isolated bacteria was performed by blood culture, together with tests of sensitivity to the most commonly used antibiotics. All tests were performed at the Microbiology Laboratory at the Health Sciences Center of the Federal University, Ceará, Brazil. Results: Of the 205 children studied, 17 presented two septic episodes, totaling 222 episodes in the period. Of all the children, 56.1% were boys, 81.4% were younger than 1 year old, 71.1% were malnourished, and 60.5% came from the countryside in Ceará. At admission, 2/3 presented with gastrointestinal problems (diarrhea) or respiratory complaints, whereas 47.7% of the episodes of sepsis were acquired in the hospital. Mortality rate was 56.1%. Blood culture results showed a predominance of the following bacteria: Staphylococcus aureus (24.8%), Klebsiella pneumoniae (22.6%), Pseudomonas aeruginosa (15.2%), Enterobacter sp (11.2%), Escherichia coli (7%), and others (19.2%). Conclusions: The epidemiological profile of the population in this study was the following: children were younger than 1 year, most of them were malnourished and presented with diarrhea or respiratory disease at admission; 40% had a disease or condition that favored the development of sepsis. The predominant bacteria were Staphylococcus aureus and Klebsiella pneumoniae.

Results

Of the 205 children studied, 17 presented two septic episodes, totaling 222 episodes in the period. Of all the children, 56.1% were boys, 81.4% were younger than 1 year old, 71.1% were malnourished, and 60.5% came from the countryside in Ceará. At admission, 2/3 presented with gastrointestinal problems (diarrhea) or respiratory complaints, whereas 47.7% of the episodes of sepsis were acquired in the hospital. Mortality rate was 56.1%. Blood culture results showed a predominance of the following bacteria: Staphylococcus aureus (24.8%), Klebsiella pneumoniae (22.6%), Pseudomonas aeruginosa (15.2%), Enterobacter sp (11.2%), Escherichia coli (7%), and others (19.2%). Conclusions: The epidemiological profile of the population in this study was the following: children were younger than 1 year, most of them were malnourished and presented with diarrhea or respiratory disease at admission; 40% had a disease or condition that favored the development of sepsis. The predominant bacteria were Staphylococcus aureus and Klebsiella pneumoniae.

Conclusions

The epidemiological profile of the population in this study was the following: children were younger than 1 year, most of them were malnourished and presented with diarrhea or respiratory disease at admission; 40% had a disease or condition that favored the development of sepsis. The predominant bacteria were Staphylococcus aureus and Klebsiella pneumoniae.

Resumen

Objetivo

Estabelecer o perfil epidemiológico e etiológico da sepse em crianças hospitalizadas no Hospital Infantil Albert Sabin - HIAS (hospital público de referência para todo o Estado do Ceará), por ser uma doença de alta prevalência nesse hospital, com mortalidade considerável.

Métodos

foram estudadas, de maneira prospectiva e consecutiva, todas as crianças internadas entre janeiro de 1993 e junho de 1994, com sepse ou que desenvolveram sepse hospitalar e que apresentaram hemoculturas positivas. O estudo epidemiológico foi realizado com preenchimento de uma ficha que compreendia: sexo, idade, procedência, estado nutricional, queixas por ocasião da hospitalização, origem da sepse (se hospitalar ou não) e desfecho do caso. O estudo microbiológico das bactérias isoladas foi realizado através de hemoculturas, acompanhadas de testes de sensibilidade aos antimicrobianos mais usados. Esses exames foram processados no Laboratório de Microbiologia do Centro de Ciências da Saúde da Universidade Federal do Ceará.

Resultados

Foram estudadas 205 crianças, das quais 17 apresentaram dois episódios de sepse, totalizando 222 episódios no período. 56,1% eram do sexo masculino, 81,4% tinham menos de um ano de idade, 71,1% eram desnutridas e 60,5% procediam do interior do Estado do Ceará. Quase dois terços apresentaram, por ocasião do internamento, queixas gastrointestinais (diarréia) ou respiratórias. Do total dos episódios de sepse, 47,7% foram contraídos no HIAS. A taxa de letalidade encontrada foi de 56,1%. Nas hemoculturas foram evidenciadas as seguintes bactérias: Staphylococcus aureus (24,8%), Klebsiella pneumoniae (22,6%), Pseudomonas aeruginosa (15,2%), Enterobacter sp (11,2%), Escherichia coli (7%) e outras (19,2%).

Conclusões

Este foi o perfil epidemiológico da população em estudo: crianças menores de 1 ano, a maioria com algum grau de desnutrição, que, ao se hospitalizarem, apresentavam como queixas, doença diarréica ou respiratória. 40% tinham doença ou situação que favorecia a instalação do quadro séptico. As bactérias predominantes foram Staphilococcus aureus e Klebsiella pneumoniae.