摘要
目的:分析肺炎链球菌感染患儿的临床特征、细菌耐药性变迁和患儿死亡危险因素,为临床诊治提供参考。方法:选取2012年1月至2019年12月中国医科大学附属盛京医院儿内科住院患儿,将入院后1周内各部位(包括肺泡灌洗液、血液、脑脊液、外耳道分泌物及局部脓肿引流液)体液细菌培养肺炎链球菌阳性的146例患儿作为研究对象,回顾性分析肺炎链球菌感染患儿的临床特征及细菌耐药性的变化情况,并根据随访结果将141例患儿分为好转组(124例)和死亡组(17例),分析肺炎链球菌感染患儿死亡的相关危险因素。结果:(1)146例患儿中,以1~3岁幼儿最多(74例,50.68%)。14例患儿存在基础疾病,包括先天发育畸形、脊肌萎缩症、癫痫等。(2)肺部感染106例(72.60%),其中侵袭性肺炎链球菌病76例(52.05%);脓毒症59例(40.41%),化脓性脑膜炎42例(28.77%)。5例患儿退院,死亡17例,其余均好转。死亡患儿中,死于多脏器功能衰竭5例,脑功能衰竭10例,重症脓毒症2例。(3)共培养肺炎链球菌阳性标本169株,血液标本51株(30.18%),脑脊液标本39株(23.08%),肺泡灌洗液标本67株(39.64%),胸水标本7株(4.14%),其余体液培养标本共5株(2.96%)。(4)万古霉素、利奈唑胺、莫西沙星、泰利霉素的敏感率均为100.00%,左氧氟沙星敏感率为98.82%,红霉素耐药率为97.01%,同时对3种以上抗生素耐药达85.61%。(5)既往抽搐、脑脊液或血培养阳性、脓毒症、脑膜炎等为死亡的危险因素( P均<0.05);死亡组患儿院外病程更短,入院24 h血红蛋白、血小板、血清白蛋白水平更低,C-反应蛋白、D-二聚体水平更高( P均<0.05)。多因素Logistic回归分析显示,低血红蛋白( OR=0.31, P=0.025)、高D-二聚体( OR=1.16, P=0.038)、脓毒性休克( OR=27.81, P=0.008)、脑脊液培养阳性( OR=6.34, P=0.034)是肺炎链球菌感染患儿死亡的独立危险因素。 结论:肺炎链球菌感染患儿平均年龄小,重症感染
Objective To analyze the clinical characteristics,changes of bacterial resistance and death risk factors of children with streptococcus pneumoniae infection,so as to provide reference for clinical diagnosis and treatment.Methods From January 2012 to December 2019,hospitalized pediatric patients at Shengjing Hospital of China Medical University were selected.Patients with streptococcus pneumoniae positive in bacterial culture in body fluids of various parts(including alveolar lavage fluid,blood,cerebrospinal fluid,external auditory canal secretions,and local abscess drainage fluid)within one week after admission were selected as subjects.The clinical characteristics and changes of bacterial resistance of 146 children with streptococcus pneumoniae infection were retrospectively analyzed,and 141 children were divided into improved group(124 cases)and death group(17 cases)according to the follow-up results,and the risk factors related to death of streptococcus pneumoniae infection were analyzed.Results(1)A total of 146 children were included,mainly at age of 1 to 3 years(74 cases,50.68%),and 14 cases had underlying diseases,including congenital malformation,spinal muscular atrophy,epilepsy and so on.(2)There were 76(52.05%)cases of invasive streptococcus pneumoniae.There were 106(72.60%)cases of pulmonary infection,59(40.41%)cases of sepsis,42(28.77%)cases of purulent meningitis,and five cases of local and pelvic abscess.Five cases were discharge from hospital,17 cases died,and the rest were all improved.Among the dead children,five cases died because of multiple organ failure,ten cases died because of brain failure and two cases died because of severe sepsis.Six deaths were complicated with septic shock.(3)There were 169 streptococcus pneumoniae positive samples,among them 51(30.18%)blood samples,39(23.08%)cerebrospinal fluid samples,67(39.64%)alveolar lavage fluid samples,seven(4.14%)pleural fluid samples,and other body fluid culture samples were five strains.(4)The sensitivity rates of vancomycin,linezolid,moxiflo
作者
王志琦
刘春峰
Wang Zhiqi;Liu Chunfeng(Pediatric Intensive Care Unit,Shengjing Hospital of China Medical University,Shenyang 110004,China)
出处
《中国小儿急救医学》
CAS
2022年第8期616-621,共6页
Chinese Pediatric Emergency Medicine
基金
辽宁省科技重大专项计划(2020JH1/10300001)
沈阳市科技计划项目(20-205-4-002)。
关键词
肺炎链球菌
侵袭性肺炎链球菌病
耐药性
预后
Streptococcus pneumoniae
Invasive pneumococcal disease
Drug resistance
Prognosis
