外周血白细胞不高的脓毒症患儿84例临床分析

目的 了解外周血白细胞不高的脓毒症患儿临床特征及病原组成。方法 选取2013-2020年河北省儿童医院住院治疗的84例外周血白细胞不高的脓毒症患儿临床资料进行回顾性分析;将仅检出革兰阳性菌患儿分为革兰阳性菌感染组(n=27),仅检出革兰阴性菌患儿分为革兰阴性菌感染组(n=26),并比较两组临床资料。结果 84例患儿,发病年龄以0~<1岁为主(47例,55.9%);伴有发热81例(96.4%),出现精神状态改变80例(95.2%);外周血C-反应蛋白中位数为157.7 g/L,降钙素原中位数为12.66 μg/L;首发感染部位呼吸系统最常见(43例,51.2%);病原微生物仅检出细菌55例(65.5%),仅检出病毒6例(7.1%),仅检出肺炎支原体2例(2.4%),多种病原共检出21例(25.0%),检出细菌中以多重耐药菌为主;诊断严重脓毒症及脓毒性休克37例(44.0%);治愈58例(69.0%)。革兰阳性菌感染组与革兰阴性菌感染组相比,首发感染部位、外周血白细胞计数、中性粒细胞计数、中性粒细胞百分数方面差异有统计学意义(P<0.05)。结论 外周血白细胞不高的脓毒症仍以多重耐药细菌感染为主,发病年龄较小,病死率较高,可根据首发感染部位、外周血白细胞及中性粒细胞计数初步判断细菌分类,早期开展经验性治疗。

Clinical analysis in 84 children with the sepsis of non-elevated peripheral blood leukocytes

Objective To understand the clinical characteristics and pathogenic composition of non-elevated peripheral blood leukocytes in children with sepsis. Methods A retrospective analysis was performed in 84 children with sepsis who had non-elevated peripheral blood leukocytes hospitalized in Hebei Children's Hospital from 2013 to 2020. Children with only gram-positive bacteria were divided into gram-positive bacteria infection group(n=27) and children only with gram-negative bacteria were divided into gram-negative bacteria infection group(n=26). Furthermore, the clinical data in groups were compared. Results In 84 children, the age of onset was mainly from 0 to <1 year (47 cases, 55.9%). There were 81 cases (96.4%) with fever and 80 cases (95.2%) with abnormal mental state. The median of peripheral blood C-reactive protein and procalcitonin were 157.7 g/L and 12.66 μg/L, respectively.Respiratory system was the most common site of first infection (43 cases, 51.2%). Fifty-five cases (65.5%) were only detected with bacteria and 6 cases (7.1%) were only detected with viruses. Two cases (2.4%) were only detected with Mycoplasma pneumoniae, and a total of 21 cases (25.0%) were detected with multiple pathogens. Among them, the majority of the detected bacteria were multi-drug resistant bacteria. Thirty-seven cases (44.0%) were diagnosed with severe sepsis and septic shock; 58 cases were cured(69.0%). Compared with the gram-negative bacteria infection group, the gram-positive bacteria infection group had statistical differences in the terms of first infection, peripheral blood white blood cell count, neutrophil count, and neutrophil percentage (P<0.05). Conclusion Multi-drug resistant bacteria are the main infections for non-elevated peripheral blood leukocytes of sepsis. The age of onset was relatively small and the mortality rate was relatively high. First-onset infection site, peripheral blood leukocytes and neutrophil counts are used to preliminarily determine bacteria identification, and carry out early empirical treatment.