婴儿B族链球菌血流感染55例临床分析  

Clinical analysis of 55 infants with group B streptococcus blood stream infection

作　　者：张交生[1] 邓继岿[1] 董意妹[2] 张蕾[3] 张锐沐 陈佳[1] 

机构地区：[1]深圳市儿童医院感染科,518038 [2]深圳市儿童医院呼吸一科,518038 [3]深圳市儿童医院重症医学科,518038 [4]汕头大学深圳儿科临床学院

出　　处：《中华传染病杂志》2017年第4期214-217,共4页Chinese Journal of Infectious Diseases

基　　金：深圳市科技计划项目（JCYJ20150403100317058）;深圳市卫生计生系统科研项目（201402045）

摘　　要：目的 总结婴儿B族链球菌（group B streptococcus,GBS）血流感染的临床特点及预后.方法 回顾性分析2010年1月1日至2015年12月31日深圳市儿童医院收治的55例GBS血流感染患儿的临床资料.结果 55例GBS感染患儿中男30例,女25例;发病年龄出生后1 h～78 d;早发型感染6例（10.9%）,晚发型感染49例（89.1%）;新生儿40例（72.7%）,婴儿15例（27.3%）.化脓性脑膜炎20例（36.4%）;外周血白细胞降低10例（18.2%）,升高32例（58.2%）;C反应蛋白升高41例（74.5%）.GBS对青霉素、氨苄西林、利奈唑胺、万古霉素100.0%（53/53）敏感,对红霉素、克林霉素、四环素、环丙沙星的耐药率分别为56.6%（30/53）、77.4%（41/53）、98.1%（52/53）、1.9%（1/53）.抗菌药物治疗中18例（32.7%）用美罗培南,37例（67.3%）用青霉素类或头孢类抗菌药物,13例（23.6%）合用利奈唑胺、3例（5.5%）合用万古霉素.37例（67.3%）联合两种抗菌药物.54例（98.2%）好转,1例（1.8%）合并多器官功能障碍、颅内出血死亡.结论 GBS血流感染对象为3个月以内的婴儿;病情重,超过1/3合并脑膜炎;青霉素敏感率为100.0%,对红霉素、克林霉素耐药率高;联合应用抗菌药物的比例高;预后欠佳.Objective To summarize the clinical characteristics and outcome of infants with group B streptococcus （GBS） blood stream infection.Methods The medical records of 55 cases with GBS blood stream infection who were hospitalized in Shenzhen Children′s Hospital from 1st January 2010 to 31st December 2015 were retrospectively analyzed.Results There were 30 boys and 25 girls in this study.The age ranged from 1 hour to 78 days.Six cases （10.9%） were early-onset and 49 cases （89.1%） were late-onset.Forty cases （72.7%） were neonates and 15 cases were infants.The meningitis was diagnosed in 20 patients （36.4%）.Peripheral white blood cell （WBC） counts declined in 10 cases （18.2%）, and elevated in 32 （58.2%） cases.Increased levels C-reactive protein were found in 41 cases （74.5%）.All of isolates were susceptible to penicillin, ampicillin, linezolid and vancomycin, while the resistance rates to erythromycin, clindamycin, tetracycline and ciprofloxacin were 56.6% （30/53）, 77.4% （41/53）, 98.1% （52/53）, and 1.9% （1/53）, respectively.Meropenem was used in 18 cases, and penicillins or cephalosporins were used in 37 cases.Combined therapy with linezolid was used in 13 cases, combined therapy with vancomycin was used in 3 cases, and combined therapy with two kinds of antibiotics was used in 37 cases （67.3%）.In clinical outcome analysis, 54 children （98.2%） were improved and 1 child （1.8%） died of complicated multiple organ dysfunction syndrome and intracranial hemorrhage.Conclusions GBS blood stream infection occurs commonly in the infants aged younger than 3 months, more than one third cases complicated with purulent meningitis.All of isolates are susceptible to penicillin, while the resistant rates are high to erythromycin and clindamycin.The percentage of combination therapy is high.The outcomes are not good.

关 键 词：无乳链球菌 婴儿 血流感染 

分 类 号：R725.1[医药卫生—儿科]