儿童血液病并发绿脓杆菌败血症的临床特点分析

Clinical features of septicemia caused by Pseudomonas aeruginosa in children with hematological disorders

目的研究儿童血液病并发绿脓杆菌败血症的临床特点及治疗效果。方法回顾性总结了1995～2005年入院的24例儿童白血病或再生障碍性贫血患儿并发绿脓杆菌败血症的临床资料,并结合血培养、药敏试验结果综合分析。结果①绿脓杆菌败血症主要发生于中性粒细胞低下的住院病人;②起病急、发展快、病情重,100%的患儿有发热,87.5%有寒战,25.0%出现感染性休克,8.3%出现DIC,20.8%出现坏疽性深脓疱;③药敏监测显示对碳青霉烯类、头孢他定等有较高的敏感率;④24例患儿中治愈22例,死亡2例,患儿在24h内应用碳青霉烯类抗感染治疗,可明显缩短发热时间和病程;中性粒细胞绝对值(ANC)<0.5×109/L、持续时间≥7d的患儿,发热持续时间及感染灶恢复时间较ANC<0.5×109/L、持续时间<7d的病人明显延长。结论绿脓杆菌败血症在粒细胞低下的血液病患儿进展极其迅速,及时有效的抗生素应用是改善预后的关键。

Objectives To investigate the clinical characteristics and treatment efficacy of Pseudomonas aeruginosa septicemia in children with hematological disorders. Methods Data of twenty-four cases with Pseudomonas aeruginosa septicemia were analyzed retrospectively. They were admitted in our hospital during 1995-2005 with underlying diseases of leukemia or aplastic anemia. Further study was done in combination with the data of blood culture and susceptibility testing. Results ①Pseudomonas aeruginosa septicemia commonly occurred in the hospitalized neutropenic patients. ②The septicemia was extremely serious with rapid progress. Fever was seen in all patients. Other manifestations included chills （87.5 %）, septic： shock （25.0 %）, DIC （8.3 %） and deep necrotizing pustules （20.8 %）. ③The susceptibility testing showed that the bacteria isolated were mostly susceptible to carbapenems and ceftazidime,etc. ④Twenty-two of the 24 pa-tients recovered completely with 2 deaths. The mortality was 8.3 %. The duration of fever and disease lasted were shorten in the patients treated with carbapenems within 24 hours after fever. Patients with absolute neutrophill count （ANC） 〈 0.5 ×10^9/L lasting ≥ 7 days had the significantly longer duration of fever and need longer time to control the infection than the patients with ANC 〈 0.5 ×10^9/L lasting 〈 7 days. Conclusions Pseudomonas aeruginosa septicemia in neutropenic patients with blood disorders progressed rapidly. It is crucial to use the most effective antibiotics in time to improve the prognosis.