摘要
目的探讨儿童脓毒性休克临床特点及血培养阳性菌耐药性分析。方法回顾性分析2015年9月至2021年8月湖南省儿童医院重症医学科收治的127例脓毒性休克患儿的临床资料、血培养阳性菌株及药敏结果。结果127例脓毒性休克患儿血培养标本共分离出134株细菌或真菌,以革兰阴性菌株为主,占67.16%(90/134)。革兰阴性菌中以流感嗜血杆菌和大肠埃希菌为主,分别占38.81%(52/134)和20.15%(27/134),而革兰阳性菌中以肺炎链球菌为主,占8.21%(11/134),真菌中以白色念珠菌为主,占10.45%(14/134)。患儿白细胞计数、血清C-反应蛋白、降钙素原、静脉血糖及动脉血乳酸较正常值均明显升高;革兰阳性菌感染时白细胞计数、中性粒细胞百分比较革兰阴性菌感染及真菌感染显著升高,差异有统计学意义(P<0.05);降钙素原在革兰阴性菌感染时升高最明显,差异有统计学意义(P<0.05)。革兰阳性菌株对万古霉素、替考拉宁和利奈唑胺均敏感,但肺炎链球菌对青霉素的敏感率仅有50%。革兰阴性菌株的耐药性相对较高,其中肺炎克雷伯菌仅对亚胺培南西司他丁和左氧氟沙星耐药率高,达到50%;流感嗜血杆菌对头孢类及β-内酰胺酶类抗生素敏感率高,仅对氨苄西林、头孢呋辛、阿米卡星和复方磺胺甲唑的耐药率为50%。真菌菌株不多,大部分抗真菌药物对血培养阳性真菌均有效。结论儿童脓毒性休克患儿感染病原菌以革兰阴性菌为主,且对一般抗生素耐药性较高,经验性使用抗生素时要注意其耐药性。
Objective To explore the clinical characteristics of children with septic shock and analyze the drug resistance of blood culture positive bacteria.Methods The clinical data,positive blood culture strains and drug sensitivity results of 127 children with septic shock admitted to the Department of Intensive Care Medicine of Hunan Children's Hospital from September 2015 to August 2021 were retrospectively analyzed.Results A total of 134 strains of bacteria or fungi were isolated from the blood culture samples of 127 children with septic shock,and gram-negative strains were the main ones,accounting for 67.16%(90/134).Haemophilus influenzae and Escherichia coli were the main gram-negative bacteria,accounting for 38.81%(52/134)and 20.15%(27/134),respectively,while Streptococcus pneumoniae was the main gram-positive bacteria,accounting for 8.21%(11/134),and Candida albicans was the main fungus,accounting for 10.45%(14/134).The number of white blood cells,the levels of serum C-reactive protein,procalcitonin,venous blood sugar and arterial blood lactic acid in patients were all significantly higher than normal values,and the white blood cells count and neutrophil percentage in gram-positive bacterial infections were significantly higher than those with gram-negative bacterial infections and fungal infections(P<0.05).Procalcitonin increased most obviously when infected by gram-negative bacteria,and the difference was statistically significant(P<0.05).Gram-positive strains were sensitive to vancomycin,teicoplanin,and linezolid,but only 50%of Streptococcus pneumoniae were sensitive to penicillin.Gram-negative strains had relatively high drug resistance,among which Klebsiella pneumoniae were only highly resistant to imipenem,cilastatin and levofloxacin,reaching 50%.Haemophilus influenzae was resistant to cephalosporins andβ-amides enzyme antibiotic,and the drug sensitivity rate of lactamase antibiotics was high,with a resistance rate of 50%only to ampicillin,cefuroxime,amikacin,and compound sulfamethoxazole.There were not many fungal strains,and most antifungal drugs were effective against blood culture-positive fungi.Conclusion The main pathogens of infection in children with septic shock are gram-negative bacteria,and have high resistance to general antibiotics.We should pay attention to their drug resistance when using antibiotics empirically.
作者
周雄
张新萍
贺杰
宋宇雷
王承娟
卢秀兰
肖政辉
Zhou Xiong;Zhang Xinping;He Jie;Song Yulei;Wang Chengjuan;Lu Xiulan;Xiao Zhenghui(Department of Critical Care Medicine,Hunan Children's Hospital,Changsha 410007,China)
出处
《中国小儿急救医学》
CAS
2024年第3期195-199,共5页
Chinese Pediatric Emergency Medicine
基金
湖南省临床医疗技术创新引导项目(2021SK50518)
湖南省卫计委一般项目(B20180575)。
关键词
脓毒性休克
危重症
儿童
耐药性
重症医学科
Septic shock
Critical illness
Children
Drug resistance
Critical care medicine
