儿童社区获得性铜绿假单胞菌血流感染的临床特征与耐药分析

Clinical profiles of community-acquired Pseudomonas aeruginosa infections in children

目的调查儿童社区获得性铜绿假单胞菌(CAPA)感染的临床特征、预后和细菌耐药性。方法回顾性队列研究,纳入2016年1月至2018年12月在我国6家三级医院进行血培养铜绿假单胞菌阳性的社区获得性感染的91例患儿为研究对象。根据菌株分离地区,分为海南地区组和其他地区组,分析比较菌株的耐药模式、临床特征、治疗和预后资料。组间比较采用χ^(2)检验、Mann-WhitneyU检验。结果91例患儿中男63例、女28例,就诊年龄22.5(5.4,44.0)月龄。海南地区组74例、其他地区组17例。24例(26%)患儿有基础疾病,常见首发症状有发热79例(87%)、咳嗽64例(70%)、喘息8例(9%)、腹泻3例(3%)和呕吐4例(4%)。28例(31%)患儿合并其他器官感染,肺炎22例(24%)、皮肤感染5例(5%)、脑膜炎、腹腔感染和上尿路感染各1例(1%)。CAPA菌株对头孢吡肟[4%(4/90)]、阿米卡星[1%(1/90)]、环丙沙星[2%(2/90)]、左氧氟沙星[1%(1/89)]的耐药率较低,对头孢他啶、哌拉西林、哌拉西林-他唑巴坦、碳青霉烯类药物的耐药率分别为12%(11/90)、3/16、18%(10/56)和6%(5/90)。52%(47/91)患儿接受联合抗菌药物进行合适的经验性治疗,59%(52/88)患儿接受联合目标治疗。放弃治疗2例(2%),死亡3例(3%)。其他地区组CAPA感染不良预后比例高于海南地区组[4/17比1%(1/74),χ^(2)=9.74,P<0.05]。结论儿童CAPA血流感染存在区域发病差异,患儿的临床症状和体征不典型,分离到的CRPA菌株耐药率低。海南地区患儿不良预后较其他地区患儿比例低。

Objectives:To investigate clinical characteristics,outcomes and antimicrobial resistance of community-acquired Pseudomonas aeruginosa(CAPA)infections in Chinese pediatric patients.Methods:This retrospective study was conducted at 6 tertiary hospitals in China during January 2016 to December 2018.The clinical and microbiological data of CAPA infected hospitalized children in Hainan and in other regions were collected and compared,and the antimicrobial resistance patterns,clinical characteristics and antibiotic therapy were analyzed.Between different groups were compared using the Chi-square test and Mann-Whitney U test.Results:Among 91 patients,63 cases were males,28 cases were females,and 74 cases were from Hainan province,17 cases were from other regians.The age of consultation was 22.5(5.4,44.0)months.Twenty-four cases(26%)had underlying diseases.Fever(79 cases(87%))and cough(64 cases(70%))were common initial symptoms.Other concomitant symptoms included wheezing 8 cases(9%),diarrhea 3 cases(3%)and vomiting 4 cases(4%).Twenty-eight cases(31%)had organ infections,including pneumonia 22 cases(24%),skin infection 5 cases(5%),meningitis,intra-abdominal infection and upper urinary tract infection each 1 case(1%).The resistance rate of CAPA isolates to cefepime(4%(4/90)),amikacin(1%(1/90)),ciprofloxacin(2%(2/90))and levofloxacin(1%(1/89))was low,and to ceftazidime,piperacillin,piperacillin-azobactam,carbapenem was 12%(11/90),3/16,18%(10/56)and 6%(5/90),respectively.Antimicrobial combination therapy accounted for 52%(47/91)of empirical therapy and 59%(52/88)of definite therapy.Two cases(2%)were hopeless discharged,and 3 cases(3%)died during hospitalization.The worse prognosis of CAPA infection is significantly different among children in other regions and in Hainan(4/17 vs.1%(1/74),χ^(2)=9.74,P<0.05).Conclusions:The invasive CAPA-infection has regional difference in incidence and prognosis in China.Clinical symptoms and signs are non-specific.CAPA strains isolated from pediatric patients display low level of resistance to most of the common antipseudomonal antibiotics.The proportion of poor prognostic outcome is lower in Hainan than in other regions.