粒细胞减少合并血流感染患儿的临床分析  

Clinical Analysis of Granulocytopenia Complicated by Bloodstream Infection in Children

作　　者：肖生平[1] 刘玉玲[1] 李小琳[1] 孔宪玲[1] XIAO Sheng-ping;LIU Yu-ling;LI Xiao-lin;KONG Xian-ling(Department of Pediatrics,Boai Hospital of Zhongshan City,Zhongshan 528400,China)

机构地区：[1]中山市博爱医院儿科,广东中山528400

出　　处：《实用临床医学（江西）》2019年第1期45-48,共4页Practical Clinical Medicine

摘　　要：目的分析粒细胞减少合并血流感染患儿的临床特点。方法收集88例粒细胞减少合并血流感染患儿的临床资料和病原学资料。结果 1)88例中粒细胞轻度减少(粒细胞减少)26例,粒细胞重度减少(粒细胞缺乏)62例;2)感染部位:除血流感染外,尚伴有其他部位感染,其中呼吸道感染25例,泌尿道感染11例,消化道感染10例,中枢感染8例,皮肤感染4例,混合感染17例,其他13例;3)感染菌株分布:G^-菌58株,其中多重耐药菌28株,非多重耐药菌30株;G^+菌30株,其中多重耐药菌12株,非多重耐药菌18株;G^-菌合并真菌感染1株;4)临床结局:G^-菌感染患儿平均热程8.59 d,G^+菌感染患儿平均热程7.57 d,二者比较差异有统计学意义(P=0.000 8);粒细胞缺乏患儿平均热程8.86 d,粒细胞减少患儿平均热程6.81 d,二者比较差异有统计学意义(P=0.03);发生多器官功能衰竭10例,死亡7例[7.95%(7/88)]。结论在粒细胞减少合并血流感染患儿中,最常见的感染部位是呼吸道,其次为泌尿道;G^-菌感染较G^+菌感染更常见,G^-菌感染患儿热程比G^+菌患儿热程长;粒细胞缺乏患儿较粒细胞减少患儿热程更长。Objective To analyze the clinical characteristics of granulocytopenia complicated by bloodstream infection in children. Methods Clinical and etiological data of 88 children with granulocytopenia and bloodstream infection were analyzed retrospectively. Results Among the 88 cases,mild neutropenia occurred in 26,and severe granulocytopenia(agranulocytosis) in 62.Most patients with bloodstream infection were accompanied by infections at other sites,including respiratory tract infection(25 cases),urinary tract infection(11 cases),digestive tract infection(10 cases),central nervous system infection(8 cases),skin infection(4 cases),mixed infection(17 cases),and other infections(13 cases).The isolated strains included 58 gram-negative bacterial strains(28 strains of multidrug-resistant bacteria and 30 strains of non-multidrug-resistant bacteria) and 30 gram-positive bacterial strains(12 strains of multidrug-resistant bacteria and 18 strains of non-multidrug-resistant bacteria).The mixed gram-negative bacterial and fungal infection was found in 1 case.The average fever course in children with gram-negative bacterial infection(8.59 days) was longer than that in those with gram-positive bacterial infection(7.57 days)( P = 0.000 8),and that in chose with agranulocytosis(8.86 days) was longer than that in those with granulocytopenia(6.81 days)( P =0.03).Ten children had multiple organ failure and 7 children died(7.95%). Conclusion In children with granulocytopenia and bloodstream infection,the most common infection site is respiratory tract,followed by urinary tract,and gram-negative bacterial infection is more common than gram-positive bacterial infection.In addition,the fever course in children with gram-negative bacterial infection and children with agranulocytosis are longer than that in those with gram-positive bacterial infection and those with granulocytopenia,respectively.

关 键 词：粒细胞减少 粒细胞缺乏 血流感染 临床特点 感染源 儿童 

分 类 号：R725.5[医药卫生—儿科]