摘要
目的探讨儿童肺炎链球菌（Sp）血流感染的易患因素、临床特征及死亡危险因素。方法回顾性分析57例Sp血流感染患儿的性别、年龄、感染类型、基础疾病等临床信息，以及部分菌株的药敏及血清型结果等。根据28 d预后分为死亡组（15例）和好转组（40例），通过多因素Logistic回归分析死亡危险因素。结果57例患儿中，男女比例为21；5岁以下为主（51例，89.5%）；社区获得性感染31例（54.4%）。发热为最常见的首发症状。并肺炎39例（68.4%），细菌性脑膜炎13例（22.8%）。28例（49.1%）有基础病，其中原发肾病综合征5例（17.2%），急性淋巴细胞白血病4例（13.8%），神经母细胞瘤4例（13.8%），15例（26.3%）其他基础病。病程中并腺病毒感染9例（15.8%），轮状病毒感染3例（5.3%）。53株Sp的药敏试验结果显示，青霉素不敏感率为43.4%，多重耐药率为88.7%。21株Sp具有血清型结果，除1株11A型外，均属于13价蛋白多糖结合疫苗（PCV13）包含的型别。28 d预后死亡组15例，病死率26.3%，好转组40例，经多变量回归分析，脑膜炎（OR＝7.611，95%CI：1.476～39.238，P＝0.015）、脓毒性休克（OR＝29.719，95%CI：2.231～395.952，P＝0.010）为患儿死亡的独立危险因素。结论Sp血流感染多为5岁以内、有基础疾病的患儿，可并病毒感染，病死率高；脑膜炎、脓毒性休克是死亡的危险因素；绝大多数菌株属于PCV13覆盖血清型。
ObjectiveTo explore the susceptible factors, clinical features and risk factors of mortality in patient with Streptococcus pneumoniae（Sp）bloodstream infections.MethodsA total of 57 patients with Sp bloodstream infection were enrolled.The data of clinical information including gender, age, source of infection, underlying disease, drug sensitivity to some bacterial strain and serotype were retrospectively analyzed.According to the prognosis on 28 day, patients were divided into death group （n=15）and recovery group （n=40）. The risk factors of mortality were analyzed by adopting multivariate Logistic regression analysis.ResultsFifty-seven cases were enrolled, in which the rate of male and female was 21, and the majority （51 cases, 89.5%）were under 5 years old, including 31 cases （54.4%）of community acquired infection.Fever was the most frequent presented symptom.Complications included 39 cases （68.4%）of pneumonia, 13 cases （22.8%）of meningitis.Twenty-eight cases （49.1%）had underlying diseases, including 5 cases （17.2%）of nephrotic syndrome, 4 cases （13.8%）of acute lymphocytic leukemia, 4 cases （13.8%）of neuroblastoma and 15 cases （26.3%）of other diseases.Viral coinfection included 9 cases （15.8%）of adenovirus and 3 cases （5.3%）of rotavirus.The results of drug sensitivity for 53 strain Sp revealed that the non-susceptible rate of penicillin was 43.4%, while multiple drug resistance was 88.7%.Twenty-one strains had serotype results, and all of them were covered by Pneumococcal 13-Valent Conjugate Vaccine（PCV13）except 1 strain of 11A.The death group contained 15 patients and the death rate was 26.3%, while 40 patients in recovery group.The independent risk factors of mortality were complicated with meningitis（OR=7.611, 95%CI： 1.476-39.238, P=0.015）or septic shock （OR=29.719, 95%CI： 2.231-395.952, P=0.010）.ConclusionThe patients with Sp bloodstream infection, under 5 years old, having underlying diseases, are susceptible to Sp bloodstream infection, and also can have coinfection with other virus.Meningitis and septic shock are the risk factors of mortality.The majority of serotype strains belong to PCV13.
出处
《中华实用儿科临床杂志》
CSCD
北大核心
2017年第24期1892-1895,共4页
Chinese Journal of Applied Clinical Pediatrics
基金
国家自然科学基金（81371853）
关键词
肺炎链球菌
血流感染
临床特征
死亡危险因素
Streptococcus pneumoniae
Bloodstream infection
Clinical features
Risk factors of mortality
