兒童血培養(yǎng)陽性的膿毒癥20例臨床分析
發(fā)布時間：2018-10-23 14:47
【摘要】：目的分析兒童膿毒癥的臨床特點(diǎn)、實(shí)驗(yàn)室指標(biāo)、血細(xì)菌培養(yǎng)、抗菌素治療及預(yù)后等,為臨床診治提供參考。方法選擇從2012年1月份至2016年12月份在廣西醫(yī)科大學(xué)第一附屬醫(yī)院兒科二病區(qū)的20例血培養(yǎng)陽性的膿毒癥住院患兒為研究對象,對其臨床資料進(jìn)行回顧性分析。結(jié)果1.一般資料:膿毒癥多見于嬰幼兒,本組資料中2歲患兒占總數(shù)的85%,合并基礎(chǔ)疾病者占80%,總體平均住院費(fèi)用為11143.00[4987.98,23858.75]元,花費(fèi)較高。2.臨床資料:總體上,社區(qū)獲得性感染相關(guān)性膿毒癥占25%(5/20),醫(yī)院獲得性感染相關(guān)性膿毒癥占75%(15/20),以醫(yī)院獲得性感染為主。G-菌感染組以夏秋季發(fā)病為主,占83.33%,G+菌感染組發(fā)生于冬春季占62.5%。膿毒癥臨床表現(xiàn)無特異性,常伴有發(fā)熱,易合并多部位感染,常見感染部位依次為呼吸系統(tǒng)、消化系統(tǒng)、皮膚軟組織等;所有患兒均出現(xiàn)不同程度的并發(fā)癥。3.實(shí)驗(yàn)室指標(biāo):G-組與G+組間白細(xì)胞計(jì)數(shù)、血小板計(jì)數(shù)、C反應(yīng)蛋白、總膽紅素、白蛋白、肌酐、尿素、活化的部分凝血活酶時間、血漿凝血酶原時間、電解質(zhì)比較,顯示無統(tǒng)計(jì)學(xué)差異。4.血培養(yǎng)及藥敏:細(xì)菌分布以革蘭陰性菌感染占主導(dǎo)地位(60%,12/20),G-菌對頭孢唑林、氨芐西林(舒巴坦)、呋喃妥因、阿莫西林、頭孢曲松、頭孢西丁、復(fù)方新諾明等耐藥率在50%以上,對慶大霉素、頭孢他啶、頭孢哌酮舒巴坦、哌拉西林他唑巴坦、亞胺培南、美羅培南耐藥性在22.2%以下,未檢出對阿米卡星、多粘菌素B、厄他培南耐藥菌株。多重耐藥菌檢出率高(50%,10/20),其中5株大腸埃希菌中檢出2株ESBLs和1株ESBLs(-)多重耐藥(MDRO)。革蘭陽性菌中,葡萄球菌所占比率最大,對苯唑西林、紅霉素、克林霉素、頭孢西丁100%耐藥,對芐青霉素耐藥率在80%以上,未檢出萬古霉素耐藥菌株。5.抗菌素使用:該組病例細(xì)菌培養(yǎng)及藥敏結(jié)果出來前均予積極經(jīng)驗(yàn)性抗感染治療,80%(16/20)的患兒所使用的抗菌素符合藥敏,其中以聯(lián)合用藥、單用頭孢三代、半合成抗銅綠假單胞菌青霉素類為主,藥敏結(jié)果出來后,敏感而聯(lián)合用藥者(8例)根據(jù)藥敏結(jié)果調(diào)整為抗菌素單藥治療,耐藥者(4例)根據(jù)藥敏結(jié)果調(diào)整使用敏感抗菌素。總體取得很好的療效。6.預(yù)后:該組病例中19例患兒治愈或好轉(zhuǎn)出院,僅1例(洋蔥伯克霍爾德菌感染膿毒癥)病情進(jìn)展出現(xiàn)呼吸衰竭,放棄治療出院。結(jié)論1.各年齡患兒均可發(fā)生膿毒癥,但多見于2歲以內(nèi)的嬰幼兒,多伴有基礎(chǔ)疾病。2.膿毒癥臨床表現(xiàn)多樣,常伴有發(fā)熱,易累及多部位,最常見原發(fā)感染灶為肺部。3.常規(guī)實(shí)驗(yàn)室檢查不能區(qū)分細(xì)菌感染的種類,抗菌素的指導(dǎo)使用仍有賴于細(xì)菌培養(yǎng)結(jié)果。4.本組病例膿毒癥細(xì)菌感染以G-菌多見,主要為大腸埃希菌、肺炎克雷伯菌、銅綠假單胞菌。此外,G+菌感染以葡萄球菌為主。多重耐藥菌株并不少見,臨床應(yīng)重視上述幾種細(xì)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.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R720.597
本文編號：2289556
[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.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R720.597
【參考文獻(xiàn)】
相關(guān)期刊論文 前10條
1 張靈玲;張朝明;謝國麗;吳心語;葛一漫;;載脂蛋白-M和白細(xì)胞介素-6等炎性反應(yīng)標(biāo)志物與細(xì)菌感染相關(guān)性及聯(lián)合診斷應(yīng)用研究[J];中華傳染病雜志;2016年01期
2 龍盼;姜麗靜;李響;孫英杰;張璐;周若雯;;革蘭氏陽性球菌和革蘭氏陰性桿菌導(dǎo)致醫(yī)院感染的患者細(xì)胞免疫功能觀察[J];臨床急診雜志;2015年12期
3 萬歲桂;鄭程程;韓旭;趙弘;孫雪靜;蘇力;夏長青;;中性粒細(xì)胞CD64指數(shù)在血液病合并細(xì)菌感染診斷中的價值[J];中國實(shí)驗(yàn)血液學(xué)雜志;2014年03期
4 王世瑜;劉曄華;張堅(jiān)磊;穆紅;;血培養(yǎng)常見病原菌分布及耐藥性分析[J];中華醫(yī)院感染學(xué)雜志;2014年01期
5 王莉敏;李艷麗;喬曉亮;;C-反應(yīng)蛋白、血清前白蛋白、血清降鈣素原聯(lián)合檢測在兒童感染性疾病中的應(yīng)用[J];中華醫(yī)院感染學(xué)雜志;2014年01期
6 王娜;樂家新;蘭曉梅;王成彬;;白細(xì)胞VCS參數(shù)及多種細(xì)胞因子診斷細(xì)菌感染性疾病的探討[J];中華醫(yī)院感染學(xué)雜志;2013年04期
7 孫樹印;劉云海;陳玉國;;膿毒癥的治療進(jìn)展[J];醫(yī)學(xué)綜述;2013年03期
8 李光輝;朱德妹;汪復(fù);倪語星;孫景勇;徐英春;張小江;胡云建;艾效曼;俞云松;楊青;孫自鏞;陳中舉;賈蓓;黃文祥;卓超;蘇丹虹;魏蓮花;吳玲;張朝霞;季萍;王傳清;王愛敏;張泓;孔菁;徐元宏;沈繼錄;單斌;杜艷;;2010年中國CHINET血流感染的病原菌分布及耐藥性[J];中國感染與化療雜志;2012年04期
9 王菲;甘小莊;宋國維;劉娟;鄭明瓊;錢素云;;北京地區(qū)兩家醫(yī)院兒科重癥監(jiān)護(hù)病房486例膿毒癥分析[J];中華兒科雜志;2012年03期
10 樓秀敏;陳虹;黃靜;;前白蛋白、白細(xì)胞計(jì)數(shù)在新生兒感染性疾病中的相關(guān)分析[J];檢驗(yàn)醫(yī)學(xué);2010年09期
，本文編號：2289556
本文鏈接：http://sikaile.net/yixuelunwen/eklw/2289556.html
最近更新
教材專著
