既往健康儿童社区感染铜绿假单胞菌败血症10例临床分析

Clinical analysis of ten cases of community-acquired pseudomonas aeruginosa sepsis in previously healthy children

目的探讨既往健康儿童社区获得性铜绿假单胞菌败血症的临床特点。方法对深圳市儿童医院2007—2008年出院诊断铜绿假单胞菌败血症的患儿资料进行回顾性分析。结果符合社区获得性铜绿假单胞菌败血症诊断标准、既往健康10例患儿,均<1岁,发病时间集中在每年4～10月。常见症状有发热、精神反应差、纳差、腹胀、腹泻、皮疹、呼吸急促。常见并发症为感染性休克、多器官功能障碍、弥漫性血管内凝血(DIC)。病程中多数患儿外周血白细胞降低,伴不同程度贫血。患儿C-反应蛋白(CRP)均显著增高,其中6例>100mg/L。细菌血培养阳性标本19份,均对哌拉西林/他唑巴坦、左旋氧氟沙星、丁胺卡那霉素、亚胺培南、氨曲南敏感,其他耐药率较低的药物依次为头孢吡肟、庆大霉素、环丙沙星、妥布霉素、头孢他啶。4例患儿入院时未选用敏感抗生素治疗,3例死亡,其中2例死于感染性休克、DIC(1例合并肺出血),1例死于肾功能衰竭。结论社区获得性铜绿假单胞菌败血症小婴儿多见,起病急,夏季发病,病死率高,并发症多。对于发热、精神反应差、有腹泻病史、病情进展迅速、早期出现感染性休克、外周血白细胞降低,特别是CRP显著增高的患儿均应考虑到本病的可能,并早期经验性使用有效抗生素治疗。

Objective To summarize the clinical features of community-acquired pseudomonas aeruginosa sepsis in previously healthy children. Methods We retrospectively reviewed the medical records of children with the diagnosis of pseudomonas aeruginosa sepsis between 2007 and 2008 in Shenzhen Children＇ s Hospital. Results Among the ten previously healthy children with community-acquired pseudomonas aeruginosa infection, younger than one year, the attack happened from April to October. The common symptoms were fever,weakness,loss of appetite, abdominal distention, diarrhea, skin rash and tachypnea. The complications included septic shock, multiple organ dysfunction syndrome and DIC. Leucocytopenia was present in sixty percent cases during the disease, all with diverse anaemia. CRP showed elevated in all cases. CRP higher than 100mg/L was present in six cases. All the isolated samples of pseudomonas aeruginosa were susceptible to Piperaeillin/Tazobactam, Levofloxacin, Amikacin, Imipenem and Aztreonam, Others drug-resistance were Cefepime, Gentamicin, Ciprofloxacin, Tobramycin and Ceftazidime. Four children were not given susceptible antibiotics on admission, of whom three died, two died of septic shock and DIC （ 1 case combined with pulmonorrhage）, and one died of acute renal failure.Conclusion Community-acquired pseudomonas aeruginosa sepsis is usually found in infants and characterized with rapid onset, occuring in summer, high mortality, and complications and severe sequelae. If a child presents fever,weakness,diarrhea, rapid aggravation,sudden septic shock or leukocytopenia with significantly elevated CRP,pseudomonas aeruginosa sepsis should be suspected and anti-pseudomonas antibiotics should be included in the initial empiric antibiotic regimen.