儿童重症监护室侵袭性肺炎链球菌病死亡患儿18例早期临床特点及药敏分析  

Early clinical characteristics and drug sensitivity analysis of 18 children died of invasive pneumococcal disease in pediatric intensive care unit

作　　者：王向蝶 方伯梁[2] 张群群 钱素云[2] 成怡冰 杨俊文 梅世月 金志鹏[1] 王琪[1] Wang Xiangdie;Fang Boliang;Zhang Qunqun;Qian Suyun;Cheng Yibing;Yang Junwen;Mei Shiyue;Jin Zhipeng;Wang Qi(Pediatric Intensive Care Unit,Children′s Hospital,Zhengzhou University,Zhengzhou 450018,China;Pediatric Intensive Care Unit,Beijing Children′s Hospital,Capital Medical University,National Children′s Medical Center,Beijing 100045,China)

机构地区：[1]郑州大学附属儿童医院儿童重症监护病房,450018 [2]国家儿童医学中心,首都医科大学附属北京儿童医院儿童重症监护病房,北京100045

出　　处：《中华实用儿科临床杂志》2020年第8期569-572,共4页Chinese Journal of Applied Clinical Pediatrics

基　　金：郑州市科技惠民计划项目(172PKJHM354)。

摘　　要：目的了解儿童重症监护病房(PICU)侵袭性肺炎链球菌病(IPD)死亡患儿的早期临床特点及药敏结果,以指导临床早期识别与治疗。方法回顾性分析2015年5月至2019年5月郑州大学附属儿童医院PICU及首都医科大学附属北京儿童医院PICU收治的IPD死亡患儿早期临床资料及药敏结果。结果符合条件的患儿18例,其中男6例,女12例;年龄2个月20 d^6岁7个月,中位数1岁9个月,其中>5岁2例(11.1%),≤5岁16例(88.9%);来自社区感染17例(94.4%)。18例患儿中,首发表现为颅内感染10例(55.6%),血行感染4例(22.2%),肺部感染3例(16.7%);合并病毒感染5例。辅助检查:18例患儿均存在贫血和低蛋白血症,15例(93.8%)患儿存在HCO3^-减低;白细胞(WBC)、血小板(PLT)、自然杀伤(NK)细胞减少的患儿分别为7例(7/18例)、12例(12/18例)、6例(5/16例),而C反应蛋白(CRP)、降钙素原(PCT)、血乳酸(LAC)、D-二聚体(D-Di)、国际标准化比值(INR)、B型钠尿肽(BNP)升高的患儿分别为12例(12/18例)、14例(14/18例)、7例(7/17例)、14例(14/17例)、5例(5/16例)、9例(9/9例)。6例(33.3%)患儿入院前未予敏感抗生素治疗。药敏分析:18份样本均为多重耐药(MDR)菌株,青霉素耐药率为22.2%,红霉素、四环素、克林霉素、复方磺胺甲唑耐药率分别为100.0%、100.0%、100.0%、94.4%,菌株对万古霉素、利奈唑胺、左氧氟沙星均敏感。结论PICU中IPD死亡患儿多≤5岁,社区感染居多;患儿均存在贫血、低蛋白血症,早期HCO3-降低及PCT、LAC、D-Di升高者可能预后不佳;IPD死亡患儿大多为MDR感染。Objective To understand the early clinical characteristics and drug sensitivity results of children died of invasive pneumococcal disease(IPD)in Pediatric Intensive Care Unit(PICU)so as to guide the early clinical identification and treatment.Methods The early clinical data and drug sensitivity result of children died of IPD in PICU of the Children′s Hospital,Zhengzhou University and Beijing Children′s Hospital,Capital Medical University from May 2015 to May 2019 were retrospectively analyzed.Results A total of 18 children meeting the criteria were enrolled,including 6 males and 12 females.The median age was 1 year and 9 months(ranged from 2 months and 20 days to 6 years and 7 months),there were 2 cases(11.1%)>5 years old,and 16 cases(88.9%)≤5 years old.There were 17(94.4%)children related to community acquired infection.Among 18 cases,the first symptom was intracranial infection in 10 cases(55.6%),bloodstream infection in 4 cases(22.2%),and pulmonary infection in 3 cases(16.7%).There were 5 cases complicated with virus infection at the same time.Auxiliary examination:all of the 18 cases had anemia and hypoalbuminemia,and 15 cases(93.8%)had HCO3^-reduction.White blood cells(WBC),platelets(PLT)and natural killer(NK)cell decreased in 7 cases(7/18 cases),12 cases(12/18 cases)and 6 cases(5/16 cases),respectively,but C-reactive protein(CRP),procalcitonin(PCT),lactic acid concentration(LAC),D-dimer(D-Di),international normalized ratio(INR)and B-type natriuretic peptide(BNP)were increased in 12 cases(12/18 cases),14 cases(14/18 cases),7 cases(7/17 cases),14 cases(14/17 cases)and 9 cases(9/9 cases),respectively.Six children(33.3%)did not receive the treatment of sensitive antibiotics before admission.According to the drug sensitivity results:all the 18 strains had multiple-drug resistance(MDR),and the resistance rates of Penicillin,Erythromycin,Tetracycline,Clindamycin and Sulfamethoxazole were 22.2%,100.0%,100.0%,100.0%and 94.4%,respectively,all the strains were sensitive to Vancomycin,Linezolid and Levofloxacin.C

关 键 词：侵袭性肺炎链球菌病 儿童医院 重症监护病房 死亡 临床特点 药敏分析 

分 类 号：R72[医药卫生—儿科]