儿童洋葱伯克霍尔德菌感染16例临床分析

Burkholderia cepacia infection in children: a clinical analysis of 16 cases

目的探讨儿童洋葱伯克霍尔德菌感染的分布特点及临床特征。方法回顾性分析2012年6月至2017年9月分离到洋葱伯克霍尔德菌的16例住院患儿的临床资料。结果 16例感染洋葱伯克霍尔德菌患儿均为散发病例,送检标本中共分离到16株洋葱伯克霍尔德菌,其中痰培养检出8株、血培养检出5株、气管插管尖端培养检出2株、肺穿刺活检物培养检出1株。16例患儿中,男性患儿11例,女性患儿5例;年龄分布在5?d至6岁之间,1岁以下的患儿占69%;科室分布上有10例在PICU/NICU,6例在普通病房;临床表现方面,除1例主要表现为弥漫性血管内凝血外,其他15例均存在有肺部感染,其中重症肺炎11例,有8例在治疗过程中行机械通气;基础疾病方面,存在严重先天性心脏病2例,明确存在原发性免疫缺陷病4例,高度怀疑存在免疫缺陷或遗传代谢病3例,气管狭窄1例,川崎病1例,早产儿并支气管肺发育不良1例,严重唇腭裂1例,无确切基础疾病3例;合并腺病毒、支原体等其他病原体感染有7例。16例患儿的平均住院天数为20.3?d,经治疗后,12例好转,4例死亡。分离到的16株洋葱伯克霍尔德菌对阿米卡星、庆大霉素耐药率为100%,对氨苄西林/舒巴坦、替卡西林/克拉维酸耐药率≥80%,对左氧氟沙星耐药率最低。结论洋葱伯克霍尔德菌为条件致病菌,发生在免疫功能低下的患儿,且易产生耐药;在抗感染治疗的同时,应注意是否存在基础疾病;洋葱伯克霍尔德菌感染患儿常预后较差,了解容易出现该菌感染的疾病谱有助于临床诊疗。

Objective To investigate the distribution characteristics and clinical features of Burkholderia cepacia infection in children. Methods A retrospective analysis was performed for the clinical data of 16 children with Burkholderia cepacia infection who were hospitalized between June 2012 and September 2017. Results All 16 children with Burkholderia cepacia infection were sporadic cases. A total of 16 strains of Burkholderia cepacia were isolated, among which 8 were detected by sputum culture, 5 were detected by blood culture, 2 were detected by tracheal intubation tip culture, and 1 was detected by lung biopsy culture. Of the 16 children, there were 11 boys and 5 girls, with an age of 5 days to 6 years, and the children aged 1 year accounted for 69%. As for department distribution, 10 children were in the PICU/NICU and 6 were in the general wards. As for clinical manifestations, one child had disseminated intravascular coagulation, and the other 15 children had pulmonary infection, among who 11 had severe pneumonia（8 of them underwent mechanical ventilation during treatment）. As for underlying diseases, 2 had severe congenital heart disease, 4 had primary immunodeficiency, 3 were highly suspected of immunodeficiency or inherited metabolic diseases, 1 had tracheal stenosis, 1 had Kawasaki disease, 1 was a preterm infant with bronchopulmonary dysplasia, 1 had severe cleft lip and palate, and 3 had no definite underlying diseases. Of all the children, 7 also had infections with adenovirus and Mycoplasma. The average length of hospital stay was 20.3 days for all children, and 12 were improved and 4 died after treatment. All 16 strains of Burkholderia cepacia had a drug resistance rate of 100% to amikacin and gentamicin and ≥80% to ampicillin/sulbactam and ticarcillin/clavulanic acid, as well as the lowest drug resistance rateto levofloxacin. Conclusions Burkholderia cepacia is an opportunistic pathogen often found in immunocompromised children and can produce drug resistance. The presence or absence of underlying diseases should be considered during anti-infective therapy. The children with Burkholderia cepacia infection often have a poor prognosis, and an understanding of the disease spectrum of Burkholderia cepacia infection helps with clinical diagnosis and treatment.