小婴儿重症无乳链球菌感染23例临床分析  

Clinical analysis of severe Streptococcus agalactiae infection in 23 small infants

作　　者：张瑾[1] 曲东[1] 刘谷月 吴雅慧 Zhang Jin;Qu Dong;Liu Guyue;Wu Yahui(Department of Critical Medicine,Children’s Hospital Affiliated to the Capital Institute of Pediatrics,Beijing 100020,China)

机构地区：[1]首都儿科研究所附属儿童医院重症医学科,北京100020

出　　处：《中华实验和临床感染病杂志(电子版)》2024年第6期369-376,共8页Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition)

基　　金：北京市医院管理中心儿科学科协同发展中心专项经费(No.XTCX201820)。

摘　　要：目的探索小婴儿重症无乳链球菌感染的临床特点。方法回顾性分析首都儿科研究所附属儿童医院重症医学科2016年1月1日~2023年12月31日血培养或脑脊液细菌培养无乳链球菌阳性住院患儿的临床资料,根据预后将入组患者分为预后不良组(11例)和治愈组(12例)。结果共纳入23例患儿,男女比例为14︰9,年龄为5~101 d,<3月婴儿占95.7%(22例)。血流感染合并化脓性脑膜炎13例(56.5%),合并血流感染4例(17.4%),合并化脓性脑膜炎6例(26.1%)。入组患儿中感染性休克12例(52.2%),多脏器功能衰竭12例(52.2%)。硬膜下积液8例(34.8%),脑室管膜炎4例(17.4%),脑积水7例(30.4%)。住院时间为28 h~74 d;治愈12例,死亡3例,遗留神经系统后遗症8例。预后不良组较治愈组患儿,病初白细胞计数[1.9(1.1,6.6)×10^(9)/L vs.11.3(3.6,16.1)×10^(9)/L:Z=-2.585、P=0.010]和血小板计数[152(78,233)×10^(9)/L vs.301(212,412)×10^(9)/L:Z=-2.523、P=0.012]更低,脑脊液白细胞[1425(290,3500)×10^(6)/L vs.153(5,1495)×10^(6)/L]更高(Z=-2.093、P=0.036),脑脊液葡萄糖[0.2(0.1,0.3)mmol/L vs.2.6(0.7,4.1)mmol/L]更低(Z=-3.171、P=0.002),脑脊液蛋白水平[5226(2935,6892)mg/L vs.937(558,2997)mg/L]更高(Z=-3.077、P=0.002),凝血功能指标凝血酶原时间[17.8(14.5,19.4)s vs.12.9(11.9,15.0)s:Z=-3.016、P=0.003]和活化部分凝血活酶时间[53.6(44.2,102.3)s vs.40.6(37.2,47.8)s:Z=-2.893、P=0.004]均延长,pH值[7.3(7.2,7.4)vs.7.4(7.3,7.4)]更低(Z=-2.585、P=0.010),应用3种及以上抗菌药物比例(81.8%vs.33.3%)更高(χ^(2)=5.490、P=0.019),成分输血比例(81.8%vs.41.7%)更高(χ^(2)=3.884、P=0.049),28 d非ICU住院时间[0(0,1.0)d vs.8.5(0.3,12.5)d]更短(Z=-2.250、P=0.024),差异均有统计学意义。结论无乳链球菌所致小婴儿感染临床表现严重,对常规使用抗菌药物中青霉素、头孢菌素敏感;但中枢神经系统受累易导致严重并发症,常见神经系统后遗症。Objective To explore the clinical characteristics of severe Streptococcus agalactiae infection in small infants.Methods Clinical data of hospitalized infants with Streptococcus agalactiae positive in blood culture or cerebrospinal fluid bacterial culture from January 1st,2016 to December 31st,2023 in the Pediatric Intensive Care Unit,Children’s Hospital Affiliated to Capital Institute of Pediatrics was analyzed,retrospectively.Results Total of 23 infants were included,the ratio of male to female was 14︰9;the diagnostic age was 5-101 days,the infants under 3 months accounted for 95.7%(22 cases).There were 13 cases(56.5%)diagnosed as septicemia and complicated with purulent meningitis,while 4 cases(17.4%)only with septicemia and 6 cases(26.1%)only with purulent meningitis.There were 12 cases(52.2%)of septic shock and 12 cases(52.2%)of multiple organ failure.Total of 8 cases(34.8%)were complicated with subdural effusion,4 cases(17.4%)complicated with ventricular meningitis and 7 cases(30.4%)complicated with hydrocephalus.The hospitalization duration was 28 hours to 74 days.Total of 12 cases were cured,3 cases died and 8 cases were left with neurological sequelae.Compared with the cured group,the poor prognosis group had lower white blood cell count[1.9(1.1,6.6)×10^(9)/L vs.11.3(3.6,16.1)×10^(9)/L:Z=-2.585,P=0.010]and lower platelet count[152(78,233)×10^(9)/L vs.301(212,412)×10^(9)/L:Z=-2.523,P=0.012],higher white blood cell count in cerebrospinal fluid[1425(290,3500)×10^(6)/L vs.153(5,1495)×10^(6)/L:Z=-2.093,P=0.036]at the beginning of illness;and had lower cerebrospinal fluid glucose[0.2(0.1,0.3)mmol/L vs.2.6(0.7,4.1)mmol/L:Z=-3.171,P=0.002],higher cerebrospinal fluid protein[5226(2935,6892)mg/L vs.937(558,2997)mg/L:Z=-3.077,P=0.002],longer prothrombin time[17.8(14.5,19.4)s vs.12.9(11.9,15.0)s:Z=-3.016,P=0.003],longer activated partial thromboplastin time[53.6(44.2,102.3)s vs.40.6(37.2,47.8)s,Z=-2.893,P=0.004],lower pH[7.3(7.2,7.4)vs.7.4(7.3,7.4):Z=-2.585,P=0.010],higher proportion of three or more antibi

关 键 词：小婴儿 无乳链球菌 重症 血流感染 脑膜炎 休克 

分 类 号：R725.1[医药卫生—儿科]