儿童急性白血病合并脓毒性休克病原菌及临床分析

Distribution of blood culture pathogens and clinical characteristics in children with acute leukemia complicated with septic shock

目的探讨儿童急性白血病合并脓毒性休克血培养病原菌情况及其临床特点。方法对70例急性白血病合并脓毒性休克患儿中血培养为阳性的病例进行回顾性分析,总结其病原学结果及临床特征。结果70例患儿中血培养阳性44例(62.9%),培养出革兰阴性菌(G-菌)33株、革兰阳性菌(G+菌)12株、真菌2株。G-菌最常见细菌为铜绿假单胞菌(8/33,24.2%),其次为大肠埃希菌(6/33,18.2%)、嗜麦芽寡养单胞菌(5/33,15.2%)和肺炎克雷伯菌(4/33,12.1%),G+菌则主要为表皮葡萄球菌、金黄色葡萄球菌、溶血葡萄球菌以及缓症链球菌(各2/12,16.7%)。45株细菌中,多重耐药菌(MDRO)占48.9%(22/45)。G-菌与G+菌患儿比较,前者在出现脓毒性休克前抗菌药物暴露时间更长(Z=-1.988,P=0.047);而两者脓毒性休克发生前住院时间、粒细胞缺乏时间及发热持续时间、明确原发感染灶、脓毒性休克发生时生命体征、发生24 h内病情严重程度、感染指标、主要治疗及临床结局方面差异均无统计学意义(P均>0.05)。与非MDRO感染患儿比较,MDRO感染患儿脓毒性休克发生前住院时间及抗菌药物暴露时间更长(t=-2.203,P=0.035;Z=-2.099,P=0.036)。多因素logistic回归分析结果显示,脓毒性休克发生前住院时间是患儿发生MDRO感染的独立危险因素(P=0.045,OR=1.059,95%CI:1.001~1.121)。结论急性白血病合并脓毒性休克患儿血培养病原菌以G-菌为主。G-菌与G+菌患儿临床特征无明显差异。住院时间越长,发生MDRO感染风险越高。

Objective To explore the distribution of blood culture pathogens and clinical characteristics in children with acute leukemia complicated with septic shock.Methods Clinical data of 70 acute leukemia children complicated with septic shock who were positive for blood culture were retrospectively analyzed.The pathogenic findings and clinical characteristics of these cases were collected.Results Among 70 children,44(62.9%)cases were positive for blood culture.33 Gram-negative bacteria(GNB),12 Gram-positive bacteria(GPB)and 2 fungi were cultured.The most common GNB was Pseudomonas aeruginosa(8/33,24.2%),followed by Escherichia coli(6/33,18.2%),Stenotrophomonas maltophilia(5/33,15.2%)and Klebsiella pneumoniae(4/33,12.1%).GPB mainly consisted of Staphylococcus epidermidis,Staphylococcus aureus,Staphylococcus haemolyticus and Streptococcus retardans(2/12,16.7%for each).Multi-drug resistant organisms(MDRO)accounted for 48.9%(22/45).Compared with GPB infections,the duration of antibiotic exposure before septic shock was significantly longer in patients with GNB infections(Z=-1.988,P=0.047).However,there were no significant differences in the length of hospital stay,duration of neutropenia and fever and site of primary infection before septic shock,vital signs,severity of illness and level of infection indicators at the onset of septic shock,primary treatment,and clinical outcome between two groups(all P>0.05).Compared with non-MDRO infected children,the length of hospital stay and the duration of antibiotic exposure before septic shock were significantly longer in MDRO infected children(t=-2.203,P=0.035;Z=-2.099,P=0.036).Multivariate logistic regression analysis indicated that the length of hospital stay before septic shock was independently associated with MDRO infections(P=0.045,OR=1.059,95%CI:1.001-1.121).Conclusions GNB are the leading pathogens of blood culture in pediatric acute leukemia complicated with septic shock.No significant difference was observed in the clinical characteristics between children infected with GNB and GPB.The longer the hospital stay,the higher the risk of MDRO infections.