既往健康儿童社区获得性铜绿假单胞菌脓毒症

Community-Acquired Pseudomonas Aeruginosa Sepsis in Previously Healthy Children

目的总结既往健康儿童社区获得性铜绿假单胞菌脓毒症的临床特点,分析导致死亡的危险因素。方法回顾性分析本院收治的34例社区获得性铜绿假单胞菌脓毒症患儿的临床资料,根据预后分为存活组、死亡或放弃治疗组,比较二组患儿年龄、性别、发病季节、入院前病程、临床表现和治疗情况。应用SPSS 11.0软件进行统计学分析。结果 34例患儿中男25例,女9例;≤1岁21例(62%);28例(82%)在5-10月份发病。存活13例(38%),其中7例有后遗症;死亡15例(44%);6例(18%)因存活概率极低家长放弃治疗。临床表现以发热、腹泻、腹胀、呼吸急促或呼吸困难最常见。20例(59%)发生皮肤坏疽性深脓疱。34例入院前均曾接受抗生素治疗,其中所用抗生素名称明确的22例,抗菌谱均未覆盖铜绿假单胞菌。入院时合并休克26例(76%)、呼吸衰竭25例(74%)、多脏器功能障碍19例(56%)。死亡或放弃治疗组休克(2χ=4.33,P=0.037)、呼吸衰竭(2χ=10.75,P=0.001)、多脏器功能障碍(2χ=9.19,P=0.002)发生率明显高于存活组。结论既往健康儿童社区获得性铜绿假单胞菌脓毒症并非罕见。可疑患儿初始抗感染治疗应使用覆盖铜绿假单胞菌的抗生素。合并休克、呼吸衰竭、多脏器功能障碍和初始抗生素使用不合理是导致死亡的危险因素。

Objective To investigate the clinical characteristics and risk factors for mortality of community-acquired pseudomonas aeruginosa sepsis in previously healthy children.Methods The materials of 34 hospitalized patients with community-acquired pseudomonas aeruginosa sepsis in previously healthy children were analyzed retrospectively.All patients were divided into survival group and death or treatments discontinued group according to the prognosis.The differences of age,gender,occurrence season,the course of disease before admission,clinical manifestations and treatments between the 2 groups were compared.Results Among the 34 patients,25 cases were male and 9 cases were female;21 cases（62%） were ≤1 year old.Twenty-eight（82%） onset occurred during May to Oct.Thirteen（38%） patients survived,and 7 cases of them were with sequelae.Fifteen patients（44%） were died,treatments discontinued in 6 patients（18%） on their parents′s order because of extremely low chances of survival.The most common symptoms were fever,diarrhea,abdominal distention and dyspnea/tachypnea.Ecthyma gangrenosum were found in 20 patients（59%）.All patients had received antibiotic therapy before admission.The antibacterial spectrum did not cover Pseudomonas aeruginosa in any one of those 22 patients whose received antibiotic name was recorded exactly.On admission,26 cases（76%） of them complicated with shock,25 cases（74%） with respiratory failure,and 19 cases（56%） with multiple organs dysfunction.The incidences of shock（χ2=4.33,P=0.037）,respiratory failure（χ2=10.75,P=0.001） and multiple organs dysfunction（χ2=9.19,P=0.002） were significantly higher in death or treatments discontinued group than those in survival group.Conclusions Community-acquired pseudomonas aeruginosa in previously healthy children is not rare.For suspected cases,it is advisable to cover for pseudomonas aeruginosa sepsis with anti-pseudomonas antibiotics.Complications including shock,respiratory failure,multiple organs dysfunction and inappropriate initial antimicrobial therapies are the risk factors for mortality.