儿童鲍曼不动杆菌血流感染临床特征及预后分析

Clinical characteristics and prognosis analysis of bloodstream infection of Acinetobacter baumannii in children

目的探讨鲍曼不动杆菌血流感染的临床特征及预后影响因素,为儿童鲍曼不动杆菌血流感染专科诊疗提供依据。方法回顾性收集2016年1月至2019年12月在郑州大学附属儿童医院住院的鲍曼不动杆菌血流感染患儿的病例资料,按照收治科室的不同,分为普通科室组(12例)和特殊科室组(11例,其中新生儿重症监护病房5例,儿科重症监护病房6例)。对患儿的一般情况、基础疾病、科室分布、住院天数、临床特征、抗生素治疗、预后转归情况进行总结,分析影响预后的危险因素。结果普通科室组患儿平均年龄为(0.35±0.46)岁,特殊科室组为(0.58±1.00)岁;普通科室组患儿合并基础疾病4例,特殊科室组5例。实验室检查提示,两组患儿入院前的血红蛋白、C-反应蛋白、降钙素原水平均高于出院前。药敏试验显示,鲍曼不动杆菌对β-内酰胺类抗生素耐药性较高,对阿米卡星敏感性较高。所有患儿均应用抗菌药物治疗,病情严重死亡2例,放弃治疗2例,好转19例,好转率为82.61%。单因素分析显示,合并基础疾病、有创侵入性操作、有抢救记录、抗菌药物应用3种以上、抗菌药物应用超过14天、住院天数超过20天是患儿预后不良的相关因素(Wals值分别为4.750、9.167、6.720、7.698、6.683、8.093,P<0.05);多因素分析显示,合并基础疾病、有抢救记录(应用呼吸机)是患儿死亡的独立预后因素(Wals值分别为3.993、5.271,P<0.05)。结论特殊科室鲍曼不动杆菌血流感染较普通科室病死率高,合并基础疾病、有抢救记录的患儿是预后差的关键因素,抗菌药物合理、恰当地使用可提高鲍曼不动杆菌血流感染的治愈率。

Objective To explore the clinical characteristics and prognostic factors of Acinetobacter baumannii bloodstream infection and provide a basis for the diagnosis and treatment of children with Acinetobacter baumannii bloodstream infection.Methods Retrospectively collected the case data of children with Acinetobacter baumannii bloodstream infection hospitalized in Children′s Hospital Affiliated of Zhengzhou University from January 2016 to December 2019.According to the different admission departments,they were divided into general department group(12 cases)and special department group(11 cases,including 5 cases in neonatal intensive care unit and 6 cases in pediatric intensive care unit).The general conditions of the children,underlying diseases,department distribution,hospitalization days,clinical characteristics,antibiotic treatment,prognostic outcomes were summarized,and the risk factors affecting the prognosis were analyzed.Results The average ages of children in the general department group and the special department group were(0.35±0.46)and(0.58±1.00)years old,respectively.There were 4 cases of children with basic diseases in general departments and 5 cases with basic diseases in special departments.Laboratory tests suggested that the levels of hemoglobin(Hb),C-reactive protein(CRP),and procalcitonin(PCT)in children in general and special departments before admission were higher than before discharge.Drug susceptibility results showed that Acinetobacter baumannii was highly resistant toβ-lactams and carbapenem antibiotics and highly sensitive to amikacin.All children were treated with antibacterial drugs.Two patients died in serious conditions,2 patients gave up treatment,19 patients improved,and the improvement rate was 82.61%.Single factor analysis found that the combination of basic diseases,invasive procedures,rescue records,the use of more than 3 antimicrobial drugs,the use of antimicrobial drugs for more than 14 days,and hospitalization for more than 20 days were related factors for poor prognosis in children(Wals=4.750,9.167,6.720,7.698,6.683 and 8.093,respectively,all P<0.05).Multivariate analysis found that the combination of underlying diseases and rescue records(using a ventilator)were independent prognostic factors for death(Wals=3.993 and 5.271,respectively,both P<0.05).Conclusion The bloodstream infection rate of Acinetobacter baumannii in special departments is higher than that of general departments.Children with basic diseases and rescue records are the key factors for poor prognosis.The rational and appropriate use of antibacterial drugs can improve the cure rate of bloodstream Acinetobacter baumannii infection.