粒细胞减少合并血流感染患儿的临床分析
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摘要
目的分析粒细胞减少合并血流感染患儿的临床特点。方法收集88例粒细胞减少合并血流感染患儿的临床资料和病原学资料。结果 1)88例中粒细胞轻度减少(粒细胞减少)26例,粒细胞重度减少(粒细胞缺乏)62例;2)感染部位:除血流感染外,尚伴有其他部位感染,其中呼吸道感染25例,泌尿道感染11例,消化道感染10例,中枢感染8例,皮肤感染4例,混合感染17例,其他13例;3)感染菌株分布:G~-菌58株,其中多重耐药菌28株,非多重耐药菌30株;G~+菌30株,其中多重耐药菌12株,非多重耐药菌18株;G~-菌合并真菌感染1株;4)临床结局:G~-菌感染患儿平均热程8.59 d,G~+菌感染患儿平均热程7.57 d,二者比较差异有统计学意义(P=0.000 8);粒细胞缺乏患儿平均热程8.86 d,粒细胞减少患儿平均热程6.81 d,二者比较差异有统计学意义(P=0.03);发生多器官功能衰竭10例,死亡7例[7.95%(7/88)]。结论在粒细胞减少合并血流感染患儿中,最常见的感染部位是呼吸道,其次为泌尿道;G~-菌感染较G~+菌感染更常见,G~-菌感染患儿热程比G~+菌患儿热程长;粒细胞缺乏患儿较粒细胞减少患儿热程更长。
Objective To analyze the clinical characteristics of granulocytopenia complicated by bloodstream infection in children.Methods Clinical and etiological data of 88 children with granulocytopenia and bloodstream infection were analyzed retrospectively.Results Among the 88 cases,mild neutropenia occurred in 26,and severe granulocytopenia(agranulocytosis) in 62.Most patients with bloodstream infection were accompanied by infections at other sites,including respiratory tract infection(25 cases),urinary tract infection(11 cases),digestive tract infection(10 cases),central nervous system infection(8 cases),skin infection(4 cases),mixed infection(17 cases),and other infections(13 cases).The isolated strains included 58 gram-negative bacterial strains(28 strains of multidrug-resistant bacteria and 30 strains of non-multidrug-resistant bacteria) and 30 gram-positive bacterial strains(12 strains of multidrug-resistant bacteria and 18 strains of non-multidrug-resistant bacteria).The mixed gram-negative bacterial and fungal infection was found in 1 case.The average fever course in children with gram-negative bacterial infection(8.59 days) was longer than that in those with gram-positive bacterial infection(7.57 days)(P=0.000 8),and that in chose with agranulocytosis(8.86 days) was longer than that in those with granulocytopenia(6.81 days)(P=0.03).Ten children had multiple organ failure and 7 children died(7.95%).Conclusion In children with granulocytopenia and bloodstream infection,the most common infection site is respiratory tract,followed by urinary tract,and gram-negative bacterial infection is more common than gram-positive bacterial infection.In addition,the fever course in children with gram-negative bacterial infection and children with agranulocytosis are longer than that in those with gram-positive bacterial infection and those with granulocytopenia,respectively.
Objective To analyze the clinical characteristics of granulocytopenia complicated by bloodstream infection in children.Methods Clinical and etiological data of 88 children with granulocytopenia and bloodstream infection were analyzed retrospectively.Results Among the 88 cases,mild neutropenia occurred in 26,and severe granulocytopenia(agranulocytosis) in 62.Most patients with bloodstream infection were accompanied by infections at other sites,including respiratory tract infection(25 cases),urinary tract infection(11 cases),digestive tract infection(10 cases),central nervous system infection(8 cases),skin infection(4 cases),mixed infection(17 cases),and other infections(13 cases).The isolated strains included 58 gram-negative bacterial strains(28 strains of multidrug-resistant bacteria and 30 strains of non-multidrug-resistant bacteria) and 30 gram-positive bacterial strains(12 strains of multidrug-resistant bacteria and 18 strains of non-multidrug-resistant bacteria).The mixed gram-negative bacterial and fungal infection was found in 1 case.The average fever course in children with gram-negative bacterial infection(8.59 days) was longer than that in those with gram-positive bacterial infection(7.57 days)(P=0.000 8),and that in chose with agranulocytosis(8.86 days) was longer than that in those with granulocytopenia(6.81 days)(P=0.03).Ten children had multiple organ failure and 7 children died(7.95%).Conclusion In children with granulocytopenia and bloodstream infection,the most common infection site is respiratory tract,followed by urinary tract,and gram-negative bacterial infection is more common than gram-positive bacterial infection.In addition,the fever course in children with gram-negative bacterial infection and children with agranulocytosis are longer than that in those with gram-positive bacterial infection and those with granulocytopenia,respectively.
引文
[1] 陈文彬.诊断学[M].5版.北京:人民卫生出版社,2001:245-245.
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[3] SEE L L.Bloodstream infection in children[J].Pediatr Crit Care Med,2005,6(S 3):S42-S44.
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[7] BLOT S,CANKURTARAN M,PETROVIC M,et al.Epidemiology and outcome of nosocomial bloodstream infection in elderly critically ill patients:a comparison between middle-aged,old,and very old patients[J].Crit Care MED,2009,37(5):1634-1641.
[8] ROBERTS F J.Definition of polymicrobial bacteremia[J].Rev Infect Dis,1989,11(6):1029-1030.
[9] HAZAN G,BEN SHIMOL S,Fruchtman Y,et al.Clinical and laboratory parameter dynamics as markers of blood stream infections in pediatric oncology patients with fever and neutropenia[J].Pediatr Hematol Oncol,2014,36(5):275-279.
[10] TSITSOPOULOS P P,ILSIFIDIS E,ANTACHOPOULOS C,et al.A 5-year epidemiological study of nosocomial blooodstream infections in a neurosurgery department[J].Infect Control Hosp Epicemiol,2010,31(4):414-417.
[11] 汪复,朱德妹,胡付品,等.2012年中国CHINET细菌耐药性监测[J].中国感染与化疗杂志,2013,13(5):321-330.
[12] 胡付品,朱德妹,汪复,等.2011年中国CHINET细菌耐药性监测[J].中国感染与化疗杂志,2012,12(5):321-329.
[13] EL MAHALLAWY H A,HASSAN S S,EL WAKIL M,et al.Increasing antimicrobial resistance monitored in surveillance analysis of blood streamInfections in febrile neutropenic pediatric oncology patients[J].Asian Pac J Cancer Prev,2015,16(14):5691-5695.
[14] 肖扬,李颂文,宋朝阳,等.恶性血液病并发院内获得性肺炎临床分析[J].中华医院感染学杂志,1999,9(2):93-94.
[15] FREIFELD A G,BOW E J,SEPKOWITZ K A,et al.Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer:2010 update by the infectious diseases society of america[J].Clin Infect Dis,2011,52(4):e56-e93.
[2] 何玺玉,陈贤楠.儿童/新生儿血流感染的定义及诊断[J].实用儿科临床杂志,2009,24(18):1385-1386.
[3] SEE L L.Bloodstream infection in children[J].Pediatr Crit Care Med,2005,6(S 3):S42-S44.
[4] SARASHINA T,KOBAYASHI R,YOSHIDA M,et al.A randomized trial of cefozopran versus cefepime as empirical antibiotic treatment of febrileneutropenia in pediatric cancer patients[J].Pediatr Blood Cancer,2014,61(11):1992-1995.
[5] PEDERSEN G,SCH?NHEYDER H C,S?RENSEN H T.Source of infection and other factors associated with case fatality in community-acquired bacteremia:a Danish population-based cohort study from 1992 to 1997[J].Clin Microbiol Infect,2003,9(8):793-802.
[6] ESBENSHADE A J,ZHAO Z,AFTANDILIAN C,et al.Multisite external validation of a risk prediction model for the diagnosis of blood streaminfections in febrile pediatric oncology patients without severe neutropenia[J].Cancer,2017,123(19):3781-3790.
[7] BLOT S,CANKURTARAN M,PETROVIC M,et al.Epidemiology and outcome of nosocomial bloodstream infection in elderly critically ill patients:a comparison between middle-aged,old,and very old patients[J].Crit Care MED,2009,37(5):1634-1641.
[8] ROBERTS F J.Definition of polymicrobial bacteremia[J].Rev Infect Dis,1989,11(6):1029-1030.
[9] HAZAN G,BEN SHIMOL S,Fruchtman Y,et al.Clinical and laboratory parameter dynamics as markers of blood stream infections in pediatric oncology patients with fever and neutropenia[J].Pediatr Hematol Oncol,2014,36(5):275-279.
[10] TSITSOPOULOS P P,ILSIFIDIS E,ANTACHOPOULOS C,et al.A 5-year epidemiological study of nosocomial blooodstream infections in a neurosurgery department[J].Infect Control Hosp Epicemiol,2010,31(4):414-417.
[11] 汪复,朱德妹,胡付品,等.2012年中国CHINET细菌耐药性监测[J].中国感染与化疗杂志,2013,13(5):321-330.
[12] 胡付品,朱德妹,汪复,等.2011年中国CHINET细菌耐药性监测[J].中国感染与化疗杂志,2012,12(5):321-329.
[13] EL MAHALLAWY H A,HASSAN S S,EL WAKIL M,et al.Increasing antimicrobial resistance monitored in surveillance analysis of blood streamInfections in febrile neutropenic pediatric oncology patients[J].Asian Pac J Cancer Prev,2015,16(14):5691-5695.
[14] 肖扬,李颂文,宋朝阳,等.恶性血液病并发院内获得性肺炎临床分析[J].中华医院感染学杂志,1999,9(2):93-94.
[15] FREIFELD A G,BOW E J,SEPKOWITZ K A,et al.Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer:2010 update by the infectious diseases society of america[J].Clin Infect Dis,2011,52(4):e56-e93.