2014-2018年儿童侵袭性流感嗜血杆菌感染84例临床特点分析  

Clinical characteristics of 84 children with invasive Haemophilus influenzae infection from 2014 to 2018

作　　者：王高良[1] 华春珍[1] 杨林海[2] 邓慧玲[3] 许红梅[4] 俞蕙[5] 王世富 张聪慧 Wang Gaoliang;Hua Chunzhen;Yang Linhai;Deng Huiling;Xu Hongmei;Yu Hui;Wang Shifu;Zhang Conghui(Department of Infectious Diseases, the Children′s Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China;Department of Cardiovascular Diseases and Rheumatology and Immunology, Shanxi Children′s Hospital, Taiyuan 030013, China;Department of Infectious Diseases, Xi′an Children′s Hospital, Xi′an 710043, China;Department of Infectious Diseases, Children′s Hospital Affiliated to Chongqing Medical University, Chongqing 400014, China;Department of Infectious Diseases, Pediatrics Hospital Affiliated to Fudan University, Shanghai 201102, China;Clinical Laboratory, Qilu Children′s Hospital, Shandong University, Jinan 250022, China;Department of Infectious Diseases, Children′s Hospital of Kaifeng City, Kaifeng 475000, China)

机构地区：[1]浙江大学医学院附属儿童医院感染科,杭州310003 [2]山西省儿童医院心血管和风湿免疫科,太原030013 [3]西安市儿童医院感染科,710043 [4]重庆医科大学附属儿童医院感染科,400014 [5]复旦大学附属儿科医院感染科,上海201102 [6]山东大学齐鲁儿童医院检验科,济南250022 [7]河南省开封市儿童医院感染科,475000

出　　处：《中华儿科杂志》2019年第8期592-596,共5页Chinese Journal of Pediatrics

摘　　要：目的了解儿童侵袭性流感嗜血杆菌(HI)感染的临床特点。方法回顾性分析7家三级儿童医院2014—2018年经细菌培养证实为侵袭性HI感染的84例患儿的临床表现、实验室检查及治疗转归特点。结果84例患儿中男50例,年龄1.54岁(5日龄~13岁)。20例(24%)患儿有基础疾病,48例(57%)患儿采集标本前未使用抗菌药物。82例(98%)患儿有发热,75例(89%)患儿有明确感染灶,其中脑膜炎、肺炎分别有31例(37%)和27例(32%)。血培养阳性62例(74%)、脑脊液培养阳性10例(12%)、血培养和脑脊液培养均阳性11例(13%)。药敏试验显示,27%(22/82)的菌株产生β内酰胺酶,48%(37/77)的菌株对氨苄西林耐药,对头孢呋辛、氨苄西林-舒巴坦、复方新诺明和阿奇霉素的耐药率分别为25%(20/80)、20%(9/45)、71%(44/62)和19%(11/58);所有菌株对美罗培南、左氧氟沙星、头孢曲松敏感。患儿经敏感抗菌药物治疗,83%(70/84)的患儿治愈好转,病死率和失访率分别为13%(11/84)和4%(3/84)。结论儿童侵袭性HI感染以脑膜炎和肺炎多见,HI脑膜炎病死率较高,头孢曲松等第三代头孢菌素可作为侵袭性HI感染治疗的首选药物。Objective To investigate the clinical characteristics of invasive Haemophilus influenzae (HI) infection in children. Methods The clinical manifestations, laboratory examinations and treatment outcomes of 84 children with HI infection confirmed by bacterial culture in 7 tertiary children′s hospitals from 2014 to 2018 were analyzed retrospectively. Results Among the 84 cases, 50 were males. The age was 1.54 years (ranged from 5 days to 13 years).Twenty cases (24%) had underlying diseases and 48 cases (57%) had not received antibiotics before collecting specimens. Eighty-two cases (98%) had fever and 75 cases (89%) had clear infection foci, among which 31 cases (37%) had meningitis and 27 cases (32%) had pneumonia. Blood culture was positive in 62 cases (74%), cerebrospinal fluid culture was positive in 10 cases (12%), blood culture and cerebrospinal fluid culture were both positive in 11 cases (13%). Antibiotics susceptibility test showed that 27%(22/82) of all HI strains produced β-lactamases and 48%(37/77) strains were resistant to ampicillin. The drug resistance rates to cefuroxime, ampicillin-sulbactam, trimethoprim-sulfamethoxazole and azithromycin were 25%(20/80), 20%(9/45), 71%(44/62) and 19%(11/58), respectively. All strains were sensitive to meropenem, levofloxacin and ceftriaxone. After sensitive antibiotic therapy, 83%(70/84) of all patients were cured and improved, the mortality rate and loss of follow-up rate were 13%(11/84) and 4%(3/84) respectively. Conclusions Meningitis and pneumonia are common presentation of invasive HI infections in children. Mortality in HI meningitis children is high and the third generation of cephalosporins, such as ceftriaxone can be used as the first choice for the treatment of invasive HI infection.

关 键 词：嗜血菌 流感 儿童 侵袭性 感染 

分 类 号：R72[医药卫生—儿科]