小儿铜绿假单胞菌脓毒症的临床特点

目的 探讨小儿铜绿假单胞菌脓毒症的临床特点及其治疗措施.方法 对广州市妇女儿童医疗中心儿童医院院区2008年5月-2010年7月收治的7例铜绿假单胞菌脓毒症病例资料进行回顾性分析.结果 7例铜绿假单胞菌脓毒症患儿中男6例,女1例;5例年龄＜1岁,最大2岁.2例患儿有基础疾病,分别为阑尾炎行阑尾切除术和粒细胞减少症;4例为社区获得性感染,3例为院内感染.患儿均有发热、皮肤损害和多器官功能损害,皮肤损害表现为坏疽性深脓疱疹,全身均可分布,肛门周围皮肤多有受累(4/7例),5例存在深部组织和体内器官的化脓性病变.患儿血培养铜绿假单胞菌均阳性,血清超敏CRP均升高,其中3例患儿还有1个或1个以上病灶组织培养出铜绿假单胞菌;外周血白细胞计数和血小板计数多降低(5/7例),患儿出现高胆红素血症和低清蛋白血症.7例入院后均进行抗生素治疗,5例住院早期即使用敏感抗生素;6例住院期间进行外科手术,2例行多次血浆置换、连续静脉-静脉血液滤过单独或联合治疗.治愈或好转出院6例,死亡1例,平均住院天数33 d.结论 社区获得性铜绿假单胞菌脓毒症并不罕见,坏疽性深脓疱疹是铜绿假单胞菌脓毒症的特征性表现.早期使用有效抗生素、适时的外科干预治疗很重要,对多器官功能损害的患者血液净化治疗有助于改善病情.     

儿童铜绿假单胞菌脓毒症1例报告

目的探讨儿童铜绿假单胞脓毒症的临床特点。方法回顾性分析1例儿童铜绿假单胞菌脓毒症的临床经过,总结其临床特点。结果患儿,男,10个月。以发热、烦躁、嗜睡,伴轻微咳嗽及喉间痰鸣为主要表现。经痰培养及血培养确诊为铜绿假单胞脓毒症,经敏感抗生素抗感染治疗后好转出院。结论正确及时选用敏感抗生素,可减少铜绿假单胞菌脓毒症引起的严重并发症及病死率。     

儿童铜绿假单胞菌脓毒症 14 例临床分析

目的了解儿童铜绿假单胞菌脓毒症的临床特点及药敏情况。方法回顾性分析2006-2016年诊断为铜绿假单胞菌脓毒症患儿的临床资料。结果符合铜绿假单胞菌脓毒症诊断患儿共14例,多于婴幼儿发病(78.6%),常见并发症为弥漫性血管内凝血(DIC)、肺出血。14例患儿中,7例治愈、4例死亡、3例因病情重家属放弃治疗。药敏结果提示所分离铜绿假单胞菌对氨基糖苷类和喹诺酮类抗生素具有良好的敏感性。结论铜绿假单胞菌脓毒症以婴幼儿多见,病死率高。对于疑诊患儿,早期抗感染治疗应使用覆盖铜绿假单胞菌的抗生素。     

小儿社区获得性铜绿假单胞菌脓毒症临床分析

目的 探讨儿童社区获得性铜绿假单胞菌脓毒症的临床特点.方法 回顾性分析复旦大学儿科医院重症监护中心2003年5月至2007年5月收治的12例铜绿假单胞菌脓毒症的发病情况.结果 12例儿童发病前均系健康儿童;突发起病,以毒血症状(12例)、高热(12例)、感染性休克(6例)、重症肺炎(12例)、特异性皮疹(6例)为主要特征,疾病进展迅速,很快发生1～6个脏器功能的衰竭;血清或渗出物培养阳性率高.药敏显示,社区获得性感染中铜绿假单胞菌对绝大部分抗革兰阴性杆菌抗生素敏感,对复方磺胺甲噁唑均耐药;12例中6例死亡.结论 铜绿假单胞菌脓毒症在儿童社区获得性感染中占有一定比例,发病有一定的特征,病情进展迅速,易导致多脏器损害.早期发现,早期干预是治疗的关键.     

儿童铜绿假单胞菌脓毒症临床特点及预后分析

目的探讨儿童铜绿假单胞菌脓毒症临床特点、高危因素及预后。方法回顾性分析16例铜绿假单胞菌脓毒症患儿的临床资料。结果儿童铜绿假单胞菌脓毒症以婴幼儿多见;临床以发热、出血性皮疹、腹泻、肝脏肿大多见;白血病、手术创伤、婴幼儿为铜绿假单胞菌脓毒症高危因素。16例患儿中痊愈11例、好转出院3例、死亡2例。治愈及好转14例中11例初始治疗抗生素对铜绿假单胞菌敏感。结论儿童铜绿假单胞菌脓毒症表现多样,白血病患儿、手术创伤、婴幼儿疑诊脓毒症时应警惕铜绿假单胞菌,合适初始抗生素治疗有利于改善预后。     

既往健康儿童社区获得性铜绿假单胞菌脓毒症

目的 总结既往健康儿童社区获得性铜绿假单胞菌脓毒症的临床特点,分析导致死亡的危险因素.方法 回顾性分析本院收治的34例社区获得性铜绿假单胞菌脓毒症患儿的临床资料,根据预后分为存活组、死亡或放弃治疗组,比较二组患儿年龄、性别、发病季节、入院前病程、临床表现和治疗情况.应用SPSS 11.0软件进行统计学分析.结果 34例患儿中男25例,女9例;≤1岁21例(62%);28例(82%)在5-10月份发病.存活13例(38%),其中7例有后遗症;死亡15例(44%);6例(18%)因存活概率极低家长放弃治疗.临床表现以发热、腹泻、腹胀、呼吸急促或呼吸困难最常见.20例(59%)发生皮肤坏疽性深脓疱.34例入院前均曾接受抗生素治疗,其中所用抗生素名称明确的22例,抗菌谱均未覆盖铜绿假单胞菌.入院时合并休克26例(76%)、呼吸衰竭25例(74%)、多脏器功能障碍19例(56%).死亡或放弃治疗组休克(χ2=4.33,P=0.037)、呼吸衰竭(χ2=10.75,P=0 001)、多脏器功能障碍(χ2=9.19,P=0.002)发生率明显高于存活组.结论 既往健康儿童社区获得性铜绿假单胞菌脓毒症并非罕见.可疑患儿初始抗感染治疗应使用覆盖铜绿假单胞菌的抗生素.合并休克、呼吸衰竭、多脏器功能障碍和初始抗生素使用不合理是导致死亡的危险因素.     

儿童社区获得性铜绿假单胞菌脓毒症：我们如何应对？

儿童社区获得性铜绿假单胞菌脓毒症虽不常见,但常常致命。发热、腹泻、呼吸困难、呼吸急促是最常见的早期症状,皮肤坏疽性深脓疱是其特征性皮肤表现。合并休克、呼吸衰竭、多器官功能障碍和初始抗生素治疗不当是死亡的风险因素。早期诊断的关键是及早进行血培养和识别特征性皮疹。对可疑病例,初始抗生素治疗应覆盖铜绿假单胞菌。     

儿童侵袭性铜绿假单胞菌感染抗菌药物治疗现状及菌株药敏分析

目的分析侵袭性铜绿假单胞菌感染(IPAI)抗菌药物治疗现状及分离菌株药敏试验结果。方法回顾分析2014年1月至2019年3月住院的61例IPAI患儿的临床资料及61株侵袭性铜绿假单胞菌(IPA)菌株的药敏试验结果,比较48例经验性抗铜绿假单胞菌治疗与13例非抗铜绿假单胞菌治疗患儿以及27例经验性碳青霉烯类治疗与19例非碳青霉烯类治疗患儿的临床特征。结果 61例IPAI患儿中,男37例、女24例,中位年龄2.1(0.6～9.1)岁。院内死亡12例(19.67%),脓毒症休克15例(24.59%)。经验性非抗铜绿假单胞菌治疗患儿感染后住院时长较抗铜绿假单胞菌治疗患儿延长,差异有统计学意义(P=0.042),而重症病房入住率、院内死亡、脓毒症休克发生率的差异无统计学意义(P0.05)。经验性碳青霉烯与非碳青霉烯治疗患儿的重症病房入住率、院内死亡、脓毒症休克发生率、感染后住院时长的差异均无统计学意义(P0.05)。61株IPA菌株对哌拉西林/他唑巴坦、头孢他啶、头孢吡肟的敏感率为85%～90%,对亚胺培南、美罗培南的敏感率为90%～95%。结论重庆地区IPA菌株对常用抗铜绿假单胞菌抗菌药物有较高敏感性,青霉素类或头孢菌素类或其β-内酰胺酶抑制剂复合制剂可作为经验性治疗IPAI患儿的首选抗菌药物。     

铜绿假单胞菌感染耐药性分析

目的　探讨小儿铜绿假单胞菌 (PA)感染患者的耐药情况。方法　对我院 2 0 0 1年 2月～ 2 0 0 3年 12月 93株PA培养标本及药敏试验结果进行回顾性分析。结果　以痰标本分离率最高 ,占 4 3.0 1% ;伤口分泌物及尿液分别占 2 6 .88%和 2 1.5 1%。对亚胺培南的耐药率最低 (7.5 3% ) ,其次为阿米卡星 (2 1.5 1% )和哌拉西林 /他唑巴坦 (32 .2 6 % )。耐药率较高的为复方磺胺甲唑 (88.17% ) ,头孢噻肟 (79.5 7% ) ,头孢曲松(6 8.82 % ) ,红霉素 (6 1.2 9% ) ,头孢哌酮 (5 6 .99% ) ,氨曲南 (5 5 .91% )。结论　PA感染呈多重耐药性 ,应注意联合用药及采取积极预防措施     

既往健康儿童社区获得性铜绿假单胞菌败血症临床分析

目的探讨既往健康儿童社区获得性铜绿假单胞菌败血症的临床特点。方法对北京儿童医院1993~2004年出院诊断铜绿假单胞菌败血症患儿进行回顾性分析。结果在符合既往健康儿童社区获得性铜绿假单胞菌败血症诊断标准的8例患儿中,4例小于1岁5例死于感染性休克(2例合并肺出血),2例存活患儿有严重后遗症,1例自动出院。本病常见症状有发热、精神反应减弱、纳差、腹胀、腹泻、皮疹、呼吸急促。常见并发症为感染性休克、多器官功能障碍、DIC。入院时一半患儿外周血白细胞降低。5例患儿进行CRP检查,4例显著增高,其中2例>100 mg/L。细菌培养阳性标本21份,全部对丁胺卡那、环丙沙星敏感,对头孢他啶、亚胺培南耐药各2份标本(各1例)。8例患儿入院时均未选用敏感抗生素治疗。结论社区获得性铜绿假单胞菌败血症小婴幼儿多见,起病急,病死率高、并发症多、后遗症严重。对于发热、精神反应减弱、有腹泻病史、病情进展迅速、早期出现感染性休克、外周血白细胞降低,特别是CRP显著增高的患儿均应考虑到本病的可能,并早期经验性使用有效抗生素治疗。     

Perianal ecthyma gangrenosum — a therapeutic dilemma

A 2-month-old premature infant was admitted to our pediatric intensive care unit because of severe Pseudomonas aeruginosa septicemia, in critical condition. A circular perianal lesion consistent with ecthyma gangrenosum developed and was treated conservatively. To our knowledge, the therapeutic dilemma between conservative and surgical management of this lesion has not been previously reported.     

Surgical strategies in the management of ecthyma gangrenosum in paediatric oncology patients

Clinical presentation and microbiology profiles of neutropenic paediatric oncology patients presenting with ecthyma gangrenosum (EG) were studied. Surgical strategies deployed for these critically ill children are reported. Between 1994 and 2005, all children with EG were identified. Case notes were reviewed. Hospital course and long-term outcome were documented. Ten patients were identified. Eight had acute lymphoblastic leukaemia, one child had acute myeloid leukaemia and another had rhabdomyosarcoma. Lesions occurred in the perineal region (n = 5), buttocks (n = 2), thigh (n = 2) and the face (n = 1). Seven children had positive blood cultures for Pseudomonas aeruginosa. Surgery included (1) radical debridement, and (2) debridement with covering colostomy for four of those with perianal lesions. Ecthyma gangrenosum is a rapidly spreading and potentially lethal condition. Paediatric oncology patients with neutropenia are at a high risk. Surgical excision is crucial for progressive lesions to prevent mortality.     

Ecthyma gangrenosum occurring at sites of latrogenic trauma in pediatric oncology patients

We report two cases of ecthyma gangrenosum which occurred at sites of iatrogenic trauma. The first case developed due to metastatic seeding with Pseudomonas aeruginosa during an episode of septicaemia and the second case occurred as a primary skin lesion. Both required prolonged courses of antibiotics and one patient died. The different pathogenic mechanisms and outcomes associated with this condition are discussed. © 1996 Wiley-Liss, Inc.     

儿童重症监护病房铜绿假单胞菌感染临床特征与耐药分析

目的 探讨儿童重症监护病房(PICU)患儿中铜绿假单胞菌(pseudomonas aeruginosa,PA)感染的临床特点及耐药情况.方法 分析我院PICU 2007年1月至2009年12月收治危重患儿中PA感染的临床情况.结果 (1) 临床特征:同期全院监测共获PA 232株,在58例PICU患儿中,共获得PA菌株112株(48.3%).社区获得性感染12例,医院获得性感染46例.死亡12例,病死率为20.7%,社区获得性感染和医院获得性感染病死率分别为41.6%(5例)和15.2%(7例),两组差异有统计学意义(P<0.05).社区获得性感染患儿主要表现为急性起病,肠道感染(5例)和败血症(5例)为主要疾病,迅速发展为休克及多器官功能障碍综合征;血白细胞不增高(7/12例)或降低(5/12例),血液C-反应蛋白和内毒素升高.医院获得性感染患儿以呼吸道感染为主要表现(38例),造成原发疾病加重,存活者住院时间延长.(2) 耐药性分析:112株PA中,头孢他丁耐药占69.8%;亚胺培南耐药率达72.8%.结论 社区获得性PA感染与医院获得性PA感染临床特征有明显差别,前者多为原发性感染,病死率高.PA为医院获得性感染重要病原之一.长时间使用广谱抗生素及侵入性医疗操作可致PA感染增多.

Abstract：

Objective To explore the clinical characteristics of critically ill children infected with pseudomonas aeruginosa(PA) and PA antibiotics resistance in pediatric intensive care unit (PICU).Methods Case records of children with PA infection admitted to PICU in children′s hospital affiliated to Shanghai Jiaotong University from Jan 2007 to Dec 2009 were reviewed for clinical characteristics,case fatality rate,prognosis and drug resistance.Results (1) Clinical features:12 cases were community-acquired infection and 46 cases were hospital-acquired infections in 58 cases.On the same period,hospital-wide surveillance obtained PA 232 strains,PICU obtained PA 112,the ratio was 48.3%.Twelve cases died and total mortality was 20.7%.The mortality was significantly difference between community-acquired infections (5 cases,41.6%)and hospital-acquired infections (7 cases,15.2%)(P<0.05).The main symptom of children with community-acquired infections were intestinal infection (5 cases) and sepsis (5 cases).The children had acute onset and developed to shock and multiple organ dysfunction syndrome rapidly.Laboratory examination revealed the white blood cell normal (7/12) and decreased in 5 cases (5/12).The value of C-reactive protein was increased significantly,and the concentration of blood endotoxin were also increased.In the hospital-acquired PA infection cases,the main symptom was respiratory abnormal (38 cases),worsen primary disease,extended staying days in PICU.(2)Drug resistance analysis:112 PA,69.8% of ceftazidime-resistant,72.8% of the imipenem-resistant.Conclusion There is significant difference of the clinical features between PA community-acquired infection and hospital-acquired infection.The former is mostly primary infections with high fatality rate.PA hospital-acquired infection has become an important pathogen of nosocomial infection in PICU.And it is important to prevent PA infection caused by a long term broad-spectrum antibiotics application and invasive medical procedures.     

Multiple ecthyma gangrenosum in a healthy infant with community-acquired Pseudomonas aeruginosa sepsis

We report the case of a previously healthy 8-month-old infant girl with Pseudomonas aeruginosa sepsis who presented to a pediatric emergency department with multiple ecthyma gangrenosum. Skin manifestations are uncommon in Pseudomonas infection. Ecthyma gangrenosum is a rare, distinct skin disorder associated with potentially fatal underlying Pseudomonas sepsis. Although typically occurring in immunocompromised or neutropenic patients, it can occasionally affect otherwise healthy children. This case demonstrates the critical importance of the pediatrician's identification of ecthyma gangrenosum to give directed antipseudomonal therapy.