25例儿童社区获得性铜绿假单胞菌血流感染的临床特点及预后影响因素

Clinical characteristics and prognostic factors of 25 cases with community-acquired pseudomonas aeruginosa bloodstream infection

目的探讨儿童社区获得性铜绿假单胞菌血流感染的临床特点及预后影响因素,为其诊治及预后评估提供依据。方法对2013年1月至2018年12月西安市儿童医院儿童重症监护病房诊断为社区获得性铜绿假单胞菌血流感染的25例患儿的资料进行回顾性分析,对其临床特点、实验室指标、药敏试验结果和疗效进行分析,并采用单因素和多因素Cox回归分析影响生存预后的相关因素。结果诊断为社区获得性铜绿假单胞菌血流感染患儿共25例,其中婴幼儿21例(84%)。25例患儿中发热23例(92%),精神反应差23例(92%),白细胞减少18例(72%),白细胞升高4例(16%),25例(100%)患儿C-反应蛋白(CRP)和降钙素原(PCT)均升高,分别为(76.6±34.3)mg/L和[35.4(7.67,43.25)]ng/ml。25例患儿中存活6例,死亡19例,病死率为76%。白细胞(Z=-2.132、P=0.033)、血乳酸(t=4.480、P<0.001)、入院前不恰当使用抗菌药物(P<0.001)、机械通气(P=0.031)、感染性休克(P<0.001)对儿童社区获得性铜绿假单胞菌血流感染预后有显著影响,差异均有统计学意义。多因素Cox回归分析显示入院前不恰当使用抗菌药物(OR=0.091、P=0.027)和感染性休克(OR=3.898、P=0.038)是儿童社区获得性铜绿假单胞菌血流感染预后的独立危险因素。结论儿童社区获得性铜绿假单胞菌血流感染表现为发热、精神差、白细胞升高或减少、CRP和PCT水平明显升高,病死率高。入院前不恰当使用抗菌药物和合并感染性休克均为患儿死亡的高危因素。合理使用抗菌药物和恰当的经验治疗将有利于降低社区获得性铜绿假单胞菌血流感染的病死率。

Objective To investigate the clinical characteristics and risk factors of prognosis in children with community-acquired Pseudomonas aeruginosa bloodstream infection and to provide basis for clinical diagnosis,treatment and prognosis evaluation.Methods The clinical data of 25 cases diagnosed as community-acquired Pseudomonas aeruginosa bloodstream infection in Pediatric Intensive Care Unit,Xi’an Children’s Hospital,from January 2013 to December 2018 were analyzed,retrospectively.The clinical characteristics,laboratory tests,drug sensitivity results and treatment were analyzed,respectively.Univariate and multivariate Cox regression were used to analyze the related factors affecting survival prognosis.Results There were 25 cases with community-acquired Pseudomonas aeruginosa bloodstream infection,21 cases were infants and toddlers.Among the 25 cases,23(92%)cases had fever,23(92%)cases had poor mental state,18(72%)cases had leukopenia,4(16%)cases had leukocytosis,C-reactive protein(CRP)and procalcitonin(PCT)increased among 25 cases(100%),which were(76.6±34.3)mg/L and[35.4(7.67,43.25)]ng/ml,respectively.Total of 19 cases survived and 6 cases died,with the fatality rate as 76%.White blood cell(Z=-2.132,P=0.033),blood lactic acid(t=4.480,P<0.001),inappropriate pre-hospital antibiotics(P<0.001),mechanical ventilation(P=0.031),septic shock(P<0.001)significantly affected the prognosis of community-acquired Pseudomonas aeruginosa bloodstream infection in children,with significant differences.Multivariate Cox regression analysis showed that inappropriate pre-hospital antibiotics(OR=0.091,P=0.027)and septic shock(OR=3.898,P=0.038)were risk factors affecting the prognosis of pseudomonas aeruginosa bloodstream infection.Conclusions Community-acquired Pseudomonas aeruginosa infection of children presents as fever,poor mental state,increased or decreased white blood cells,significantly increased CRP and PCT,with high fatality rate.Inappropriate pre-hospital antibiotics and septic shock were independent risk factors for prognosis of community-acquired pseudomonas aeruginosa bloodstream infection in children.Rational use of antibiotics and more approriate antimicrobial therapy might improve the outcomes of children with community-acquired Pseudomonas aeruginosa bloodstream infection.