白血病患儿中性粒细胞缺乏合并草绿色链球菌脓毒症临床分析  

Clinical analysis of agranulocytosis complicated with viridans streptococcal sepsis in leukemia children

作　　者：万媛媛 吴珺 张乐萍[3] WAN Yuanyuan;WU Jun;ZHANG Leping(Department of Pediatrics,Peking University International Hospital,Beijing 102206,China;Department of Pediatrics,Peking University Shougang Hospital,Beijing 100041,China;Department of Pediatrics,Peking University People's Hospital,Beijing 100044,China)

机构地区：[1]北京大学国际医院儿科,北京102206 [2]北京大学首钢医院儿科,北京100041 [3]北京大学人民医院儿科,北京100044

出　　处：《临床儿科杂志》2021年第9期695-699,共5页Journal of Clinical Pediatrics

摘　　要：目的了解儿童白血病中性粒细胞缺乏合并草绿色链球菌脓毒症的危险因素及临床特征。方法回顾分析111例白血病中性粒细胞缺乏合并脓毒症患儿的临床资料。结果111例患儿共发生136例次脓毒症,检测到138株菌株,其中25株为草绿色链球菌。25例次草绿色链球菌脓毒症中,男12例次、女13例次,脓毒症发生时中位年龄98(66~138)月,距末次化疗结束中位时间9(6~10)d,中性粒细胞缺乏已持续中位时间5(4~6)d,脓毒症发生时中性粒细胞中位值0.01(0~0.01)×10^(9)/L。25例次均有发热,热峰(39.3±0.7)℃,中位发热持续时间1.5(1.0~2.8)d;11例次存在口腔感染,7例次合并上呼吸道感染,3例次继发肺部感染,1例次合并胃肠炎,1例次合并感染中毒性脑病;5例次除发热外无其他感染症状。将138株菌株分为草绿色链球菌组(25株)、非草绿色链球菌革兰阳性菌组(14株)及革兰阴性菌组(99株)3组,三组间年龄、急性髓系白血病所占比例、热峰、口腔感染发生率差异均有统计学意义(P<0.05);草绿色链球菌组急性髓系白血病及口腔感染比例较高。草绿色链球菌对万古霉素、利奈唑胺及氯霉素100%敏感,对大环内酯类及青霉素类耐药率较高。结论草绿色链球菌是白血病中性粒细胞缺乏合并脓毒症的常见病原体,急性髓系白血病及口腔感染是感染该菌高危因素,万古霉素及利奈唑胺可作为粒细胞缺乏发热合并口腔感染患儿的经验用药。Objective To explore the risk factors and clinical characteristics of agranulocytosis combined with viridans streptococcal bacteremia in children with leukemia.Methods The clinical data of 111 children with agranulocytosis complicated with sepsis were analyzed retrospectively.Results A total of 136 instances of sepsis occurred in 111 children,and 138 strains were detected,of which 25 strains were viridans streptococcus.Among the 25 insatnces(12 boys and 13 girls)of viridans streptococcal sepsis,the median age at the onset of sepsis was 98(66-138)months,the median time from the end of the last chemotherapy was 9(6-10)d,and the median duration of agranulocytosis was 5(4-6)d.The median value of neutrophils at the onset of sepsis was 0.01(0-0.01)×10^(9)/L.All the 25 cases had fever,with a heat peak of(39.3±0.7)℃,and the median duration of fever was 1.5(1.0-2.8)d.Among them,11 cases had oral infections,7 cases had upper respiratory tract infections,3 cases had secondary lung infection,1 case had gastroenteritis,1 case had combined toxic encephalopathy,and 5 cases had no other infection symptoms except fever.The 138 strains were divided into three groups:viridans streptococcus group(25 strains),non-viridans streptococcus gram-positive bacteria group(14 strains),and gram-negative bacteria group(99 strains).There were statistically differences in age,proportion of acute myeloid leukemia,the peak heat and incidence of oral infection among the three groups(P<0.05).The viridans streptococcus group had higher proportion of acute myeloid leukemia and oral infection.Viridans streptococci were 100%sensitive to vancomycin,linezolid and chloramphenicol,and had a high resistance rate to macrolides and penicillins.Conclusions Viridans streptococci are a common pathogen of agranulocytosis complicated with sepsis.Acute myeloid leukemia and oral infection are high risk factors for viridans streptococci infection.Vancomycin and linezolid can be used as empirical drugs for children with agranulocytosis fever complicated with oral in

关 键 词：草绿色链球菌 白血病 脓毒症 中性粒细胞缺乏 儿童 

分 类 号：R733.7[医药卫生—肿瘤]