儿童血培养阳性的脓毒症20例临床分析

发布时间：2018-10-23 14:47

【摘要】：目的分析儿童脓毒症的临床特点、实验室指标、血细菌培养、抗菌素治疗及预后等,为临床诊治提供参考。方法选择从2012年1月份至2016年12月份在广西医科大学第一附属医院儿科二病区的20例血培养阳性的脓毒症住院患儿为研究对象,对其临床资料进行回顾性分析。结果1.一般资料:脓毒症多见于婴幼儿,本组资料中2岁患儿占总数的85%,合并基础疾病者占80%,总体平均住院费用为11143.00[4987.98,23858.75]元,花费较高。2.临床资料:总体上,社区获得性感染相关性脓毒症占25%(5/20),医院获得性感染相关性脓毒症占75%(15/20),以医院获得性感染为主。G-菌感染组以夏秋季发病为主,占83.33%,G+菌感染组发生于冬春季占62.5%。脓毒症临床表现无特异性,常伴有发热,易合并多部位感染,常见感染部位依次为呼吸系统、消化系统、皮肤软组织等;所有患儿均出现不同程度的并发症。3.实验室指标:G-组与G+组间白细胞计数、血小板计数、C反应蛋白、总胆红素、白蛋白、肌酐、尿素、活化的部分凝血活酶时间、血浆凝血酶原时间、电解质比较,显示无统计学差异。4.血培养及药敏:细菌分布以革兰阴性菌感染占主导地位(60%,12/20),G-菌对头孢唑林、氨苄西林(舒巴坦)、呋喃妥因、阿莫西林、头孢曲松、头孢西丁、复方新诺明等耐药率在50%以上,对庆大霉素、头孢他啶、头孢哌酮舒巴坦、哌拉西林他唑巴坦、亚胺培南、美罗培南耐药性在22.2%以下,未检出对阿米卡星、多粘菌素B、厄他培南耐药菌株。多重耐药菌检出率高(50%,10/20),其中5株大肠埃希菌中检出2株ESBLs和1株ESBLs(-)多重耐药(MDRO)。革兰阳性菌中,葡萄球菌所占比率最大,对苯唑西林、红霉素、克林霉素、头孢西丁100%耐药,对苄青霉素耐药率在80%以上,未检出万古霉素耐药菌株。5.抗菌素使用:该组病例细菌培养及药敏结果出来前均予积极经验性抗感染治疗,80%(16/20)的患儿所使用的抗菌素符合药敏,其中以联合用药、单用头孢三代、半合成抗铜绿假单胞菌青霉素类为主,药敏结果出来后,敏感而联合用药者(8例)根据药敏结果调整为抗菌素单药治疗,耐药者(4例)根据药敏结果调整使用敏感抗菌素。总体取得很好的疗效。6.预后:该组病例中19例患儿治愈或好转出院,仅1例(洋葱伯克霍尔德菌感染脓毒症)病情进展出现呼吸衰竭,放弃治疗出院。结论1.各年龄患儿均可发生脓毒症,但多见于2岁以内的婴幼儿,多伴有基础疾病。2.脓毒症临床表现多样,常伴有发热,易累及多部位,最常见原发感染灶为肺部。3.常规实验室检查不能区分细菌感染的种类,抗菌素的指导使用仍有赖于细菌培养结果。4.本组病例脓毒症细菌感染以G-菌多见,主要为大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌。此外,G+菌感染以葡萄球菌为主。多重耐药菌株并不少见,临床应重视上述几种细菌的感染。
[Abstract]:Objective to analyze the clinical features, laboratory indexes, blood bacteria culture, antibiotic therapy and prognosis of children with sepsis, so as to provide reference for clinical diagnosis and treatment. Methods from January 2012 to December 2016, 20 hospitalized children with sepsis with positive blood culture were selected from the second Hospital of Pediatrics, first affiliated Hospital of Guangxi Medical University as the research objects, and their clinical data were analyzed retrospectively. Result 1. General data: sepsis was more common in infants and infants. In this group, 85 cases were aged 2 years old, 80 cases were complicated with basic diseases. The total average hospitalization cost was 11143.00 yuan [4987.980.23858.75] yuan, and the cost was higher. Clinical data: in general, 25% (5 / 20) of community-acquired infection associated sepsis, 75% (15 / 20) of nosocomial infection associated sepsis, mainly nosocomial infection. The clinical manifestations of sepsis were nonspecific, often accompanied with fever, and easily complicated with multiple site infection. The common infection sites were respiratory system, digestive system, skin soft tissue, etc. Laboratory parameters: WBC count, platelet count, C-reactive protein, total bilirubin, albumin, creatinine, urea, activated partial thromboplastin time, plasma prothrombin time, electrolyte, No statistical difference. 4. Blood culture and drug sensitivity: Gram-negative bacteria were dominant in bacterial distribution (60 / 12 / 20). The resistance rates of G- bacteria to cefazolin, ampicillin, furantoin, amoxicillin, ceftriaxone, cefoxitin and compound sulbactam were over 50%. The resistance to gentamicin, ceftazidime, cefoperazone sulbactam, piperacillin tazobactam, imipenem and meropenem was less than 22. 2%. The detection rate of multidrug resistant bacteria was high (50 / 10 / 20). Two strains of ESBLs and one strain of ESBLs (-) multidrug resistant (MDRO). Were detected in 5 strains of Escherichia coli. Among Gram-positive bacteria, Staphylococcus was the largest. It was resistant to oxacillin, erythromycin, clindamycin, cefoxitin in 100%, and benzyl penicillin resistance rate was more than 80%. Vancomycin resistant strains were not detected. Antimicrobial use: the bacterial culture and drug sensitivity of the patients were treated with positive empirical anti-infective therapy before they came out. 80% (16 / 20) of the children were treated with antibiotics in accordance with the drug sensitivity, in which combined use was used only for the third generation of cephalosporium. The semi-synthetic anti-Pseudomonas aeruginosa penicillin was the main drug. After the results of drug sensitivity, the sensitive and combined drugs (8 cases) were adjusted to antibiotic monotherapy according to the results of drug sensitivity, and the drug resistant cases (4 cases) adjusted the use of sensitive antibiotics according to the results of drug sensitivity. Overall achieved very good results. 6. Prognosis: 19 cases were cured or discharged from hospital, only 1 case (infection with sepsis of Bacillus cepacia) developed respiratory failure and was discharged from hospital. Conclusion 1. Sepsis can occur in children of all ages, but is more common in infants under 2 years of age, with underlying diseases. 2. 2. Sepsis clinical manifestations are diverse, often accompanied by fever, easy to involve many parts, the most common primary infection of the lung. 3. Routine laboratory tests can not distinguish the types of bacterial infections, and the use of antibiotics still depends on the results of bacterial culture. 4. 4. G- bacteria were the most common bacterial infections in this group, mainly Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa. In addition, Staphylococcus was the main infection of G bacteria. Multidrug resistant strains are not uncommon, clinical attention should be paid to the infection of these bacteria.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R720.597

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