54例儿童铜绿假单胞菌血流感染临床特点及耐药分析
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摘要
目的探讨儿童铜绿假单胞菌(PA)血流感染的临床特点及耐药情况。方法回顾分析2013年1月至2017年11月因PA血流感染而住院患儿的临床资料。结果 54例PA血流感染患儿中,新生儿败血症2例、脓毒症51例、菌血症1例;有基础疾病34例,既往体健20例。54例患儿起病均有发热,以精神反应差、腹泻及皮肤损害起病为主,且上述症状比例在既往体健组中均高于有基础疾病组,差异有统计学意义(P<0.05)。54例患儿中44例(81.48%)存在其他系统受累,最易受累的是呼吸系统,其次为电解质紊乱、血液系统、多器官衰竭;既往体健组出现呼吸、血液、神经、循环、消化系统受累,皮肤损害,多器官衰竭及电解质紊乱的概率均高于有基础疾病组,差异有统计学意义(P<0.05)。既往体健组白蛋白降低者更多,C反应蛋白和降钙素原水平更高,差异有统计学意义(P<0.05)。不恰当使用抗生素的23例患儿中,耐药性最高的为氨曲南,其次为头孢他啶、哌拉西林。23例预后不良。结论儿童PA血流感染易发生多器官损害,不恰当抗生素使用率高,预后不良。
Objective To investigate the clinical characteristics and resistance of Pseudomonas aeruginosa(PA)bloodstream infections in children. Methods The clinical data from 54 hospitalized children of PA bloodstream infections were retrospectively analyzed. Results Of them, 2 cases were septicemia, 51 cases were sepsis, 1 case was bacteremia. 34 cases had underlying diseases, and 20 cases occurred in previously healthy children. All the children had a fever. The other main symptoms were poor spirit and reaction, diarrhea and skin damage, and the proportion of the above symptoms was significantly higher in previously healthy group than in underlying disease group, the difference was statistically significant(P<0.05). Of the 54 patients, 44( 81. 48 %) had other system involvement, the most common is vulnerable respiratory system, followed by electrolyte imbalance, hematological system and multiple organ failure. In the previously healthy group, the incidence of respiratory,hematological, nervous, circulatory, digestive system and skin damage, multiple organ failure and electrolyte imbalance were significantly higher than that of the underlying disease group, the difference was statistically significant(P<0.05). The albumin in the previously healthy group decreased more, and the median level of CRP and PCT was higher, the difference was statistically significant(P<0.05). Improper antibiotic treatments were found in 23 cases, the highest resistance was Aztreonam, followed by Ceftazidime, and Piperacillin. Poor prognosis was observed in 23 cases. Conclusions PA bloodstream infections in children are prone to multiple organ damage, and with high rate of improper use of antibiotics and poor prognosis.
Objective To investigate the clinical characteristics and resistance of Pseudomonas aeruginosa(PA)bloodstream infections in children. Methods The clinical data from 54 hospitalized children of PA bloodstream infections were retrospectively analyzed. Results Of them, 2 cases were septicemia, 51 cases were sepsis, 1 case was bacteremia. 34 cases had underlying diseases, and 20 cases occurred in previously healthy children. All the children had a fever. The other main symptoms were poor spirit and reaction, diarrhea and skin damage, and the proportion of the above symptoms was significantly higher in previously healthy group than in underlying disease group, the difference was statistically significant(P<0.05). Of the 54 patients, 44( 81. 48 %) had other system involvement, the most common is vulnerable respiratory system, followed by electrolyte imbalance, hematological system and multiple organ failure. In the previously healthy group, the incidence of respiratory,hematological, nervous, circulatory, digestive system and skin damage, multiple organ failure and electrolyte imbalance were significantly higher than that of the underlying disease group, the difference was statistically significant(P<0.05). The albumin in the previously healthy group decreased more, and the median level of CRP and PCT was higher, the difference was statistically significant(P<0.05). Improper antibiotic treatments were found in 23 cases, the highest resistance was Aztreonam, followed by Ceftazidime, and Piperacillin. Poor prognosis was observed in 23 cases. Conclusions PA bloodstream infections in children are prone to multiple organ damage, and with high rate of improper use of antibiotics and poor prognosis.
引文
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[12]Chuang CH,Wang YH,Chang HJ,et al.Shanghai fever:a distinct Pseudomonas aeruginosa enteric disease[J].Gut,2014,63(5):736-743.
[13]高恒淼,曾健生,陈晖,等.既往健康儿童社区获得性铜绿假单胞菌脓毒症[J].中华实用儿科临床杂志,2011,26(10):749-751.
[14]祝俊英,王春,张泓,等.2005-2014年CHINET儿童患者分离革兰阴性菌耐药性监测[J].中国感染与化疗杂志,2016,16(4):437-448.
[15]任伟,龙晓玲,周涛,等.儿童铜绿假单胞菌脓毒症14例临床分析[J].临床儿科杂志,2016,34(9):674-676.
[16]徐保平,钱素云,申昆玲.既往健康儿童社区获得性铜绿假单胞菌败血症临床分析[J].中国小儿急救医学,2006,13(6):521-523.
[17]Zádori D,Klivényi P,Szalárdy L,et al.Mitochondrial disturbances,excitotoxicity,neuroinflammation and kynurenines:novel therapeutic strategies for neurodegenerative disorders[J].J Neurol Sci,2012,322(1-2):187-191.
[2]Yang MA,Lee J,Choi EH,et al.Pseudomonas aeruginosa bacteremia in children over ten consecutive years:analysis of clinical characteristics,risk factors of multi-drug resistance and clinical outcomes[J].J Korean Med Sci,2011,26(5):612-618.
[3]Zhang Q,Smith JC,Zhu Q,et al.A five-year review of Pseudomonas aeruginosa bacteremia in children hospitalized at a single center in southern China[J].Int J Infect Dis,2012,16(8):e628-e632.
[4]旷凌寒,江咏梅,胡正强,等.儿科血液病房血培养病原菌分布及耐药情况分析[J].中国当代儿科杂志,2013,15(4):259-263.
[5]Asgari S,Mclaren PJ,Peake J,et al.Exome sequencing reveals primary immunodeficiencies in children with community-acquired Pseudomonas aeruginosa sepsis[J].Front Immunol,2016,7:357.
[6]Kuo KC,Kuo HC,Huang LT,et al.The clinical implications of ABO blood groups in Pseudomonas aeruginosa sepsis in children[J].J Microbiol Immunol Infect,2013,46(2):109-114.
[7]黄碧茵,郭青云,刘郴州.儿童社区获得性铜绿假单胞菌脓毒症15例[J].中华实用儿科临床杂志,2016,31(10):798-800.
[8]Yan W,Li W,Mu C,et al.Ecthyma gangrenosum and multiple nodules:cutaneous manifestations of Pseudomonas aeruginosa sepsis in a previously healthy infant[J].Pediatr Dermatol,2011,28(2):204-205.
[9]周益平,张育才.铜绿假单胞菌脓毒症的临床特征与救治策略[J].中国小儿急救医学,2011,18(4):375-377.
[10]Vaiman M,Lasarovitch T,Heller L,et al.Ecthyma gangrenosum versus ecthyma-like lesions:should we separate these conditions?[J].Acta Dermatovenerol Alp Pannonica Adriat,2015,24(4):69-72.
[11]梁跃波.小儿社区获得性铜绿假单胞菌败血症8例的治疗经验与教训[J].儿科药学杂志,2010,16(1):20-22.
[12]Chuang CH,Wang YH,Chang HJ,et al.Shanghai fever:a distinct Pseudomonas aeruginosa enteric disease[J].Gut,2014,63(5):736-743.
[13]高恒淼,曾健生,陈晖,等.既往健康儿童社区获得性铜绿假单胞菌脓毒症[J].中华实用儿科临床杂志,2011,26(10):749-751.
[14]祝俊英,王春,张泓,等.2005-2014年CHINET儿童患者分离革兰阴性菌耐药性监测[J].中国感染与化疗杂志,2016,16(4):437-448.
[15]任伟,龙晓玲,周涛,等.儿童铜绿假单胞菌脓毒症14例临床分析[J].临床儿科杂志,2016,34(9):674-676.
[16]徐保平,钱素云,申昆玲.既往健康儿童社区获得性铜绿假单胞菌败血症临床分析[J].中国小儿急救医学,2006,13(6):521-523.
[17]Zádori D,Klivényi P,Szalárdy L,et al.Mitochondrial disturbances,excitotoxicity,neuroinflammation and kynurenines:novel therapeutic strategies for neurodegenerative disorders[J].J Neurol Sci,2012,322(1-2):187-191.
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