儿童无病灶肺炎链球菌菌血症39例临床特征分析

Analysis of clinical characteristics of 39 children with occult pneumococcal bacteremia

目的探讨儿童无病灶肺炎链球菌菌血症(OPB)的临床特征和适宜治疗方案。方法收集深圳市儿童医院2013年1月至2018年12月儿内科病房39例符合入组标准的OPB患儿的病历资料,对其临床特征、药敏结果、抗生素应用情况等进行回顾性分析。结果OPB患儿发病中位年龄2岁4个月,74.4%(29/39例)的患儿年龄6个月~3岁;平均总热程3.69 d(1~14 d),平均住院时间6.74 d;89.7%(35/39例)的患儿外周血白细胞计数>15×10^9/L,76.9%(30/39例)的患儿C-反应蛋白升高,38.9%(14/36例)的患儿降钙素原>2 mg/L;住院期间患儿均接受静脉抗生素治疗,初始抗生素选择:头孢呋辛[11例(28.2%)]、阿莫西林舒巴坦钠[10例(25.6%)]、头孢曲松钠[7例(17.9%)],美洛西林舒巴坦[6例(15.4%)];抗生素治疗平均1.4 d后热退,平均静脉抗生素疗程6.2 d;药敏结果提示青霉素不敏感率为46.2%,阿莫西林、头孢曲松和头孢噻肟不敏感率分别为22.2%、10.3%、17.9%,红霉素100.0%耐药,万古霉素和利奈唑胺未发现耐药。结论OPB好发于6个月~3岁婴幼儿,对阿莫西林、头孢曲松和头孢噻肟耐药率低,对于免疫力健全的儿童抗生素治疗后热退快,预后好。

Objective To explore the clinical characteristics and appropriate treatment of occult pneumococcal bacteremia(OPB)in children.Methods The clinical characteristics,drug sensitivity and antibiotic use of 39 children with OPB who met the inclusion criteria in the Pediatric Internal Medicine Ward of Shenzhen Children′s Hospital from January 2013 to December 2018 were retrospectively analyzed.Results The median age of onset in OPB in children was 2 years and 4 months,and 74.4%of children(29/39 cases)were between 6 months and 3 years.The average total fever duration was 3.69 days(1-14 days),and the average hospital stay was 6.74 days.Peripheral blood white blood cell count was>15×10^9/L in 89.7%(35/39 cases)of the children,C-reactive protein was increased in 76.9%(30/39 cases)of the children,and procalcitonin>2 mg/L in 38.9%(14/36 cases)of the children.During hospita-lization,all the children received the treatment of intravenous antibiotics.The antibiotics used initially included Cefuroxime in 11 cases(28.2%),Amoxicillin sulbactam sodium in 10 cases(25.6%),Ceftriaxone sodium in 7 cases(17.9%)and Meloxicillin sulbactam in 6 cases(15.4%).The average fever clearance time after the antibiotic therapy was 1.4 days,and the average intravenous antibiotics treatment time was 6.2 days.The results indicated that the insensitivity rate of Penicillin was 46.2%,the insensitivity rate of Amoxicillin,Ceftriaxone and Cefotaxime were 22.2%,10.3%and 17.9%,respectively,Erythromycin resistant rate was 100.0%,and no patient was resistant to Vancomycin and Linezolid.Conclusions OPB occurs most frequently in infants aged from 6 months to 3 years old,with low drug resistance to Amoxicillin,Ceftriaxone and Cefotaxime.Children with complete immunity have shorter fever duration and good prognosis after antibiotic treatment.