摘要
目的分析儿童侵袭性A组β溶血性链球菌感染的临床特点及细菌耐药性．以提高诊断和治疗水平。方法回顾性分析2004年1月至2011年12月住院的19例侵袭性A组β溶血性链球菌感染患儿的病史和细菌药敏试验资料。由正常无菌部位分离出A组β溶血性链球菌诊断为侵袭性A组β溶血性链球菌感染。结果19例患儿中男15例，女4例，男女比例为3．75：1；年龄1d～14岁，中位年龄4岁；入院时病程4h～10d；平均住院时间12．2d；冬春季发病13例，社区获得性感染18例。临床诊断脓肿10例；化脓性腹膜炎4例；链球菌中毒休克综合征伴脓胸3例；脓气胸和新生儿败血症各1例。3例存在基础疾病，其中2例为车祸外伤，1例为先天性食管闭锁、气管食管瘘。检出A组13溶血性链球菌前人住重症监护病房5例，人住时问1～32d；4例接受气管捅管、机械通气，通气时间8h～24d；2例曾接受外科手术。5例合并其他病原感染，其中4例腹腔脓液同时培养出大肠埃希菌，1例呼吸道分泌物检出副流感病毒I型。16例有发热，热程3～14d；外剧血白细胞升高18例，下降1例。C反应蛋白均升高，其中16例在14～160mg/L，3例，〉160mg/L。自19例患儿无菌部位共检出20株A组B溶血性链球菌，其中10株分离白脓肿切开术后脓液，各有4株分离白血液和腹水，2株分离自同一患儿的胸水。所有菌株对头孢唑林、左氧氟沙星及万古霉素敏感；对青霉素和头孢噻肟的耐药率分别为10．0％和15．4％；对红霉素和克林霉素的耐药率分别为55．0％和70．0％。3例治愈，14例好转，2例死亡，其中1例死于链球菌中毒休克综合征继发多器官功能障碍，1例死于基础疾病继发多器官功能障碍。结论儿童侵袭性A组β溶血性链球菌感染以脓肿最常见，也可导致严重的链球菌中毒休克综合征甚至死亡。青霉素和头孢菌素仍是敏感的抗菌药�
Objective Group A β-hemolytic streptococcus （GAS） or Streptococcus pyogenes may be encountered in diverse clinical situations in children. A rising incidence of invasive group A streptococcus （IGAS） infections has been noted in children in the past three decades. The aim of this study was to smnmarize the clinical characteristics and antimicrobial resistance of IGAS in children, and to raise the level of diagnosis and treatment of this infection. Method The clinical data from 19 cases of IGAS younger than 14 years old seen from January 2004 to December 2011 treated in the authors＇ hospital were analyzed. IGAS infections are defined as the isolation of GAS from a normally sterile site in patients. Result The 19 cases were identified as IGAS infections, among whom 15 were male and 4 were female, and the ratio of them was 3.75. The age ranged from 1 day to 14 years, with a median age of 4 years. The course of disease was 4 h - 10 days. The average length of stay was 12. 2 days. In 13 cases the episodes of the infection occurred in winter and spring. In 18 cases the infection was community-acquired. Overall, 10 cases had neck or foot dorsum abscess, four cases had purulent peritonitis, and 3 cases were diagnosed as streptococcal toxic shock syndrome （STSS） complicated with empyema, pyopneumothorax occurred in 1 case and neonatal septicemia in another. Three cases had an underlying disease, including 2 cases wounded in a car accident and 1 ease of congenital esophageal atresia and traeheoesophageal fistula. Before the isolation of GAS, 5 cases hadstayed in ICUs, the length of ICU stay was 1 - 32 days, 4 cases had received intubation and mechanical ventilation, the ventilation time was 8 h -24 days, 2 cases had received major surgery; 5 cases had other pathogen coinfeetion, including 4 cases of abdominal pus at the same time and Escherichia coli was isolated, and I case had parainfluenza virus type I coinfection. Peripheral blood leucocyte increased in 18 cases, one case dropped off. The C-reactive prote
出处
《中华儿科杂志》
CAS
CSCD
北大核心
2014年第1期46-50,共5页
Chinese Journal of Pediatrics
关键词
链球菌属
抗药性
体征和症状
软组织感染
Streptoc, oecus
Drug resistance
Signs and symptoms
Soft tissue infections
