摘要
目的探讨肺炎链球菌性蜂窝组织炎患儿的临床特征。方法回顾性分析2012年1月至2017年12月18家儿童医院的细菌培养信息管理系统的信息,收集到确诊为侵袭性肺炎链球菌病(IPD)的1138例患儿中感染类型为蜂窝组织炎的住院患儿共7例,对其临床特点进行分析。结果7例肺炎链球菌性蜂窝织炎患儿占18家医院IPD患儿的0.6%(7/1138例)。其中男5例,女2例;起病年龄1个月~6岁,中位年龄为2岁。农村4例,城市3例。1例存在基础疾病,为朗格汉斯细胞组织细胞增生症(LCH)。临床表现:发热、伴感染灶局部红肿热痛等表现。蜂窝织炎病灶部位:眼眶蜂窝织炎2例,面颊部感染2例,上肢、头部及臀部感染各1例。病初情况:2例眼眶蜂窝织炎患儿分别伴鼻窦炎和化脓性中耳炎,1例为急性根尖周炎治疗后,1例为化疗结束后10个月。并发感染类型:7例中并血流感染6例,并细菌性脑膜炎2例,并肺炎1例。其他培养结果:外周血培养为肺炎链球菌6例,病灶局部脓液培养阳性2例。菌株药物敏感试验:青霉素和头孢菌素(头孢噻肟/头孢曲松)敏感6例,耐药1例。治疗:3例单用头孢菌素类药物治疗,2例头孢菌素联合青霉素类治疗,2例脑膜炎患儿予万古霉素联合美罗培南治疗;3例局部脓肿者予切开引流;2例脑膜炎患儿收住重症监护病房,1例予气管插管呼吸机辅助通气。住院时间14.3 d(5~41 d)。出院结局:6例好转,1例死亡。结论蜂窝组织炎是儿童IPD的少见感染类型,多见于3岁及以下儿童,以头面部和眶周为主要感染部位,可伴血流感染或细菌性脑膜炎,多数预后良好。
Objective To explore the clinical characteristics of children with Streptococcus pneumoniae cellulitis.Methods The bacterial culture information management system in 18 children′s hospitals from January 2012 to December 2017 were reviewed.Among 1138 children diagnosed with invasive pneumococcal disease(IPD),7 cases were hospitalized with cellulitis.Clinical information was collected and analyzed.Results Seven cases of Streptococcus pneumoniae cellulitis accounted for 0.6%(7/1138 cases)of 1138 IPD cases in 18 hospitals.There were 5 males and 2 females.The onset age was from 1 month to 6 years old,and the median age was 2 years old.There were 4 cases in rural areas and 3 cases in urban areas.Langerhans cell histiocytosis(LCH)was found in 1 case.Clinical manifestations:fever,local swelling and pain with infection.The focus of cellulitis:orbital cellulitis in 2 cases,buccal infection in 2 cases,upper extremity,head and buttock infection in 1 case,respectively.At the beginning of the disease:2 cases of orbital cellulitis were accompanied by nasosinusitis and suppurative otitis media,1 case was treated with acute periapical inflammation,1 case was 10 months after chemotherapy.Type of infection:6 cases were complicated with bloodstream infection,2 cases with bacterial meningitis and 1 case with pneumonia.Other culture results:6 cases of Streptococcus pneumoniae were cultured in peripheral blood,2 cases were positive in local pus culture.Drug sensitivity test:6 cases were sensitive to Penicillin and Cephalosporin(Cefotaxime/Ceftriaxone),1 case was resistant.Treatment:3 patients were treated with Cephalosporins alone,2 cases with Cephalosporins and Penicillins,2 cases with Vancomycin and Meropenem for meningitis,3 cases with local abscess by incision and drainage,2 cases with meningitis in Intensive Care Unit,and 1 case with endotracheal intubation and ventilator assisted ventilation.The average length of stay was 14.3 days(5-41 days).Discharge outcome:6 cases improved and 1 case died.Conclusions Cellulitis is a rare ty
作者
朱亮
刘钢
邓慧玲
李文辉
邓继岿
毕晶
刘静
赵仕勇
陈必全
Zhu Liang;Liu Gang;Deng Huiling;Li Wenhui;Deng Jikui;Bi Jing;Liu Jing;Zhao Shiyong;Chen Biquan(Key Laboratory for Major Disease in Children,Ministry of Education,Department of Infectious Diseases,Beijing Children′s Hospital,Capital Medical University,National Center for Children′s Health,Beijing 100045,China;Department of Infectious Disease,Children′s Hospital of Xi′an,Xi′an 710003,Shaanxi Province,China;Department of Infectious Disease,Children′s Hospital of Hebei Province,Shijiazhuang 050031,Hebei Province,China;Department of Infectious Disease,Shen-zhen Children′s Hospital,Shenzhen 518038,Guangdong Province,China;Department of Infectious Disease,Baoding Children′s Hospital,Baoding 071000,Hebei Province,China;Department of Infectious Disease,Hunan Children′s Hospital,Changsha 410007,China;Department of Infectious Disease,Hangzhou Children′s Hospital,Hangzhou 310014,Zhejiang Province,China;Department of Infectious Disease,Anhui Provincial Children′s Hospital,Hefei 230051,China)
出处
《中华实用儿科临床杂志》
CSCD
北大核心
2020年第8期609-612,共4页
Chinese Journal of Applied Clinical Pediatrics
基金
福棠儿童科学基金(FTCSF-2018-01)
北京市医院管理中心儿科学科协同发展中心专项经费资助(XTZD20180501)
北京市医院管理局"登峰"人才培养计划团队(DFL 20181201)。
关键词
肺炎链球菌
蜂窝织炎
儿童
Streptococcus pneumoniae
Cellulitis
Child
