儿童感染性心内膜炎35例分析

目的了解儿童感染性心内膜炎(IE)的临床特点、病原谱特征、耐药状况及预后。方法回顾性分析2007年6月1日至2014年12月31日确诊为IE患儿的临床及病原学资料。结果研究年限内共确诊IE 35例,男15例、女20例,平均年龄为(6.56±0.81)岁。原有先天性心脏病23例(65.7%)。赘生物形成24例(68.6%)。57.4%的患儿有长期发热。血培养阳性19例,占54.3%;其中83.3%为革兰阳性球菌,包括凝固酶阴性葡萄球菌、草绿色链球菌和肠球菌。所有阳性球菌均对万古霉素敏感。结论先天性心脏病是IE的易感因素,感染细菌以革兰阳性球菌为主,对万古霉素敏感。     

儿童感染性心内膜炎临床表现与治疗对策

目的分析儿童感染性心内膜炎的临床特征、治疗和预后。方法回顾性分析1998—2012年收治的83例感染性心内膜炎患儿的临床资料。结果共83例患儿,男53例、女30例,平均年龄(6.8±4.6)岁,临床特征以发热(77.1%)、轻中度贫血(71.1%)、C反应蛋白升高(67.5%)、红细胞沉降率增高(60.2%)、白细胞增高(47.0%)为主;出现栓塞症状20例(24.1%);血培养阳性56例(67.5%),以革兰阳性菌为主,链球菌属及葡萄球菌属占89.3%;万古霉素等敏感抗生素治疗有效;超声检查检出赘生物68例(82%)。55例(66.2%)患儿接受心脏手术,最终死亡7例(8.4%)。结论近年来感染性心内膜炎的病原菌变迁,缓症链球菌及金黄色葡萄球菌成为主要病原菌,需万古霉素等敏感抗生素治疗;心脏超声检出赘生物阳性率较高。     

小儿感染性心内膜炎的诊治(附24例报告)

感染性心内膜炎(IE)目前在心血管病中仍然是一个严重的疾病,病死率占30～40%。为早期诊断及提高抗生素疗效,本文总结我院24例IE的临床资料,并就IE的诊断和治疗加以讨论。本组病例的诊断标准为:在先天性或后天性心脏病的基础上,长期原因不明的发热,同时具备以下任何1～2项者;①脾脏肿大,②心脏杂音,③杵状指,④瘀点,⑤欧氏小结,⑥肺栓塞,脑栓塞或血尿,⑦血培养1次阳性,⑧超声心动图显示赘生物,⑨进行性贫血。临床资料我院自1974年1月～1983年5月共收治IE患儿24例,其中男性10例,女性14例;年龄最小3天,最大12岁.其中,22例原有先天性心脏病,2例心脏正常者均为葡萄球菌败血症。     

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目的探讨儿童感染性心内膜炎(IE)的临床特点、治疗方法及转归。方法回顾分析中南大学湘雅二医院儿科1980—2004年确诊的174例IE患儿的临床特点。174例患儿中男94例,女80例,年龄3个月至14岁,病程3d至4个月。结果(1)99例IE发生在先天性心脏病的基础上,35例发生在风湿性心脏病的基础上,35例发生在无器质性心脏病基础上,4例于先天性心脏病手术后发生,1例发生在肥厚性心肌病的小儿。(2)临床主要表现:发热(150例,86·2%)、肝大(74例,42·5%)、脾大(55例,31·6%)、贫血(65例,37·4%)、血沉增快(68例,39·1%)、多发性脏器栓塞(34例,17·8%)。细菌培养76例(76/174)阳性,阳性率43·7%,其中55例为葡萄球菌。(3)受累瓣膜以二尖瓣赘生物最多见,占48·3%。(4)并发症以顽固性心衰为主(25·2%),其次为神经系统并发症(13·2%),瓣膜腱索断裂最少见(0·57%)。(5)由于IE临床表现很不典型,病例早期被误诊为流感、肺结核、急性风湿热、肾小球肾炎等10余种疾病。(6)治愈率为60·9%,其中单用抗生素治疗治愈76例(71·6%),抗感染治疗联合外科手术治愈30例(28·3%)。死亡28例(16·1%),脑栓塞及顽固性心衰是IE最常见的死亡原因。结论发生IE的基础心脏病中,先天性心脏病跃居首位,风湿性心脏病逐渐减少。血培养、超声心动图检查有助于IE的诊断。对于IE最重要的治疗措施是应用抗生素,若经内科治疗效果不满意应尽早考虑外科治疗。     

感染性心内膜炎30例临床及预后分析

为探讨感染性心内膜炎（IE）的临床特及预后因素，对15年来的收治的30例IE患儿的所有资料进行回顾性调查，结果30例IE患儿治愈9例，死亡5例；持续发热为其主要表现，血培养阳性18例（60．0％），其中金葡菌9例（50．0％）；超声检查发现赘生物21例，有赘生物及基础心脏病组死亡率为23．8％和25．0％，无赘生物和无基础心脏病组无死亡；栓塞组死亡21．4％，无栓塞组为12．5％；血培养阳性组死亡22．2％，阴性组为8．3％。提示IE的显著症状是持续发热，金葡菌感染占首位，预后与赘生物、栓塞、基础心脏病存在和血培养阳性有关。     

儿童感染性心内膜炎36年的临床变迁

目的为了解儿童感染性心内膜炎(IE)临床变迁的趋势,为早期诊断和治疗提供参考.方法将1964～1983年我院确诊的IE患儿34例(A组)与1984～1999年的38例(B组)进行临床对比分析.临床资料包括基础疾病、临床表现、血培养致病菌的种类、超声心动图(UCG)检查的情况、治愈率和病死率.结果72例IE患儿的基础疾病包括先天性心脏病40例,后天性心脏病16例,其他疾病16例.B组风湿性心脏病的比例为13%,较A组的27%有所下降;而B组无基础心脏病者(29%)较A组(15%)增加,两组基础疾病的构成差异无显著性(x2=3.685,P＞0.05).B组瘀点(斑)、脾肿大、动脉栓塞的发生率较A组虽有所下降,但差异无显著性(x2分别为3.34、2.18、0.37,P＞0.05),而心力衰竭的发生率则较A组明显上升,两组比较差异有显著性(x2=9.34,P＜0.01).B组金黄色葡萄球菌的发生率(14%)低于A组(55%)(经Fisher精确计算,P=0.081).而其他革兰阳性球菌包括四联球菌、腐生葡萄球菌、表皮葡萄球菌的发生率(64%)明显高于A组(0)(经Fisher精确计算,P=0.001).结论IE发生于先天性心脏病者仍居首位,近16年风湿性心脏病作为引起IE的基础疾病的比例有所下降,而无基础心脏病者增加;致病菌中金黄色葡萄球菌减少,而条件致病菌明显增加;临床表现心力衰竭明显增加.强调UCG在诊断IE中有重要价值,合理治疗可改善预后.     

新生儿败血症近十年病原菌变迁及临床特征分析

目的 探讨近十年本院新生儿败血症临床特征、病原菌及耐药情况.方法 选择2002年1月至2011年12月我院收治的1 068例新生儿败血症血培养阳性患儿的临床资料,分为对照组(前5年,568例)及观察组(后5年,500例),对两组患儿的主要临床特征及并发症、致病菌及药敏结果进行回顾性分析.结果 (1)两组新生儿败血症血培养阳性分别为568例及500例,其阳性检出率分别占同期住院患儿的3.8％及2.3％.(2)两组临床特征中发热、并发化脓性脑膜炎的患儿分别为58例及76例,76例及124例,差异有统计学意义(P＜0.05).(3)两组血培养检出病原菌菌种分别是18种和28种;两组表皮葡萄球菌检出率均居首位,分别为360例及238例,各占64.3％及47.6％,对照组依次为其他葡萄球菌41例(7.2％),溶血葡萄球菌及屎肠球菌35例(6.2％),大肠埃希菌22例(3.9％)居第4位;而观察组居第2位的是大肠埃希菌71例(14.2％),其次为溶血葡萄球菌44例(8.8％),肺炎克雷白杆菌25例(5.5％)居第3位.(4)两组耐甲氧西林凝固酶阴性葡萄球菌耐药菌株分别检出25例及34例(P＜0.05).结论 新生儿败血症的主要病原菌是葡萄球菌和大肠埃希菌;以发热为主要症状的败血症及并发化脓性脑膜炎的病例也明显增多;病原菌的耐药性增加;应高度重视病原学检查,合理选择抗生素.     

儿童肺栓塞30例临床分析及病因探讨

目的探讨儿童肺栓塞的临床特征、病因及抗凝治疗的有效性和安全性。方法回顾性分析2017年1月至2021年12月在山东第一医科大学附属省立医院儿科诊断为肺栓塞并接受抗凝治疗的30例患儿资料, 分析其病因、临床特点、合并症、抗凝治疗转归及预后情况。结果 30例患儿中男17例, 女13例;年龄(8.95±2.58)岁(4～13岁), 随访时间3～59个月。1.临床表现咳嗽30例(100.0%), 发热29例(96.7%), 气促27例(90.0%), 胸痛15例(50.0%), 咯血9例(30.0%), 无咯血但支气管镜检查发现血性分泌物4例(13.3%), 呼吸衰竭2例(6.7%)。2.原发病中肺炎支原体感染23例(76.7%)并符合难治性肺炎支原体肺炎诊断, 肺炎支原体耐药突变点2063A>G或2064A>G阳性16例(53.3%), 肾病综合征2例(6.7%), 紫癜性肾炎(肾病综合征型)1例(3.3%), 狼疮性肾炎(肾病综合征型)1例(3.3%), 遗传性蛋白S缺乏症1例(3.3%), 骨髓炎并金黄色葡萄球菌败血症1例(3.3%), 先天性心脏病1例(3.3%)。3.合并...     

金黄色葡萄球菌感染性心内膜炎11例报告

1986年11月～1992年5月根据临床症状、血培养及超声心动图等检查诊断为金葡菌感染性心内膜炎(IE)11例,现报告如下。 临床资料 一、临床资料 男6例,女5例;8个月～1 3/12岁4例,3～7岁3例,10～12岁4例。其中先天性心脏病(含VSD、PDA、TOF)5例,风湿性心脏病1例。诊断依据:在有或无先天性、风湿性心脏病的基础上长时间(2周以上)不规则发热,可除外其他发热性疾病;血培养生长金葡菌;同时具备下述1项以     

V3通用引物联合多重PCR检测感染性心内膜炎病原菌

目的 了解2007年至2010年21例在上海儿童医学中心接受手术治疗的急性感染性心内膜炎(infective endocarditis,IE)患儿的病原菌分布.方法 21例IE患儿均行血培养、赘生物培养及赘生物PCR检测(以16SrRNA基因的保守区序列V3为靶基因);对葡萄球菌进行多重PCR扩增检测耐甲氧西林葡萄球菌.结果 21例IE患儿赘生物PCR阳性检出率95.2％,血培养阳性检出率57.1％,赘生物阳性检出率9.5％,3种方法阳性检出率的差别有统计学意义(P ＜0.0001).其中1例心内膜赘生物的PCR结果与血培养结果不一致,赘生物PCR结果为放射菌,血培养结果为溶血巴斯德菌,利用血培养得到的菌落进行PCR检测,与赘生物PCR的结果一致,均为伴放线放线杆菌;其余11例心内膜标本的PCR结果与血培养结果一致.多重PCR技术检测mecA基因能快速、敏感、准确地检测耐甲氧西林葡萄球菌,与femA基因联合检测能有效检测耐甲氧西林金黄色葡萄球菌,及时提示临床使用糖肽类抗生素.21例患儿均痊愈出院,术后随访无感染复发.结论 V3通用引物联合多重PCR法可提高IE患儿赘生物病原菌检出率,且受抗菌药物的影响小,适用于符合手术指征且血培养阴性或鉴别困难的病原学诊断,有利于手术后抗菌药物的选用及提高IE的最终治愈率.     

Infective endocarditis in children

Between January 1977 and December 1982, 34 patients below the age of 20 years (age range 1.9–20 yr, mean 12.3 years) were treated for 38 episodes of infective endocarditis (IE). Twenty three patients (68%) had rheumatic heart disease (RHD), while 11 had congenital heart disease (CHD). Echocardiography was diagnostic of IE in 10 of 12 patients (83%) in whom it was performed. Blood culture was positive in only 15 instances (40%), staphylococcus being the most common organism isolated. Twenty eight (74%) episodes of IE resulted in a cure by medical treatment. Ten patients (26%) died during the medical treatment 9(90%) because of relentless congestive heart failure and 1(10%) due to cerebral embolism. Infective endocarditis in children is an important therapeutic problem. Culture negative endocarditis is frequent in our setting.     

Forty Year Review of Bacterial Endocarditis in Infants and Children

From 1950 through 1989 at Tokyo University's Department of Pediatrics, 25 children were treated for bacterial endocarditis. Twenty-two of these patients had previously been diagnosed as suffering from congenital heart disease. Twenty one of the 25 patients had positive blood cultures. Streptococcus viridans was the most common organism isolated, although the incidence of Streptococcus viridans infection has decreased in the last 20 years. In present series only a few post-surgical cases with congenital heart disease occurred. There were three deaths which all occurred prior to 1965.     

Paediatric infective endocarditis: 19-year experience at a tertiary care hospital in a developing country

A retrospective study was undertaken to study children who presented with infective endocarditis (IE) to a university teaching hospital in Beirut, Lebanon, between January 1977 and May 1995. Of 41 patients with IE (24F, 17M), 28 (68%) were diagnosed between 1977 and 1985. Patients' ages ranged from 3 to 18 y (mean age 11.3+/-2.8 y), and 13 patients were <10 y of age. Clinical presentations included: fever (in 88%), heart failure (in 39%), neurologic findings (in 20%) and embolic phenomena (in 22%). Nineteen patients (46%) had underlying congenital heart disease (CHD) with tetralogy of Fallot and pulmonary stenosis being the most common. Sixteen patients (39%) had underlying rheumatic heart disease (RHD). A total of 5 children (12%) with normal cardiac anatomy had IE. One had underlying acquired viral myocarditis with mitral insufficiency. Echocardiography showed vegetations in 60%. Blood cultures were positive in 31 patients (76%). IE occurred in three patients following cardiac surgery. In one patient it occurred within 2 mo of surgery and in the other two it occurred within 6 mo. Streptococcus viridans and Staphylococcus aureus were the two most commonly isolated bacteria. Overall mortality rate was 29% (not statistically significant between patients presenting between 1977-1985 and 1986-1995; p = 0.17). There was no statistically significant difference in mortality among the groups (five in the group with CHD, six with RHD and one with structurally normal heart). This study demonstrates that RHD is an important underlying cause of IE in children in our community. This finding is similar to those in other developing countries and different from those in developed countries. Distribution of pathogens and CHD in our study is comparable to some reports in the literature, except for the higher proportion of patients with underlying pulmonary stenosis. Bacterial endocarditis prophylaxis should be emphasized in patients with RHD or pulmonary stenosis.     

小儿感染性心内膜炎死亡危险因素及病原学特点分析

目的 分析小儿感染性心内膜炎死亡的危险因素及病原学特点.方法 运用回顾性病例对照研究策略对2000年1月至2007年6月间上海儿童医学中心收治的46例感染性心内膜炎患儿的临床资料进行总结,研究因素包括性别、原发病、感染部位、培养结果 、并发症、治疗措施等16个变量,建立Logistic回归模型.结果 感染性心内膜炎患儿(46例)占同期住院患儿总数的0.78‰,其中40例有心脏疾患,左侧心内膜炎的发病率比右侧高.24例血培养阳性,1例赘生物菌培养阳性,总的细菌培养阳性率为54%.在25例阳性结果 中,革兰阳性菌15例,其中常见病原菌为α-溶血性链球菌;革兰阴性菌7例;真菌3例.46例患儿治愈40例,死亡6例.Logistic回归模型示与死亡有关的因素包括血培养阴性(OR=25.127,95%CI为1.110～363.236)、血液疾病(OR=28.620,95%CI为2.261～354.448)和多器官功能衰竭(OR=19.843,95%CI为0.786～221.754).结论 小儿感染性心内膜炎的病原菌以α-溶血性链球菌最常见,左侧心内膜炎的发病率比右侧高.血培养阴性、血液疾病和多器官功能衰竭是预后不良的危险因素.     

Infective Endocarditis in Swedish Children

ABSTRACT. A retrospective study of Swedish children with infective endocarditis (IE) during the period 1971-80 was made. Sixty-six instances were identified in 64 children (0.39 cases per 100000 children per year). Fifty (78%) had a previously known heart disease. Most commonly this was a ventricular septal defect and tetralogy of Fallot. Seventy-one percent had positive blood cultures. Streptococcus viridans and Staphylococcus aureus were most commonly isolated. Twenty-two percent of the children had undergone previous cardiac surgery. One case closely followed cardiac surgery and in only nine children could a definite port of entry of infection be demonstrated.     

Infective endocarditis in Swedish children. I. Incidence, etiology, underlying factors and port of entry of infection

A retrospective study of Swedish children with infective endocarditis (IE) during the period 1971-80 was made. Sixty-six instances were identified in 64 children (0.39 cases per 100,000 children per year). Fifty (78%) had a previously known heart disease. Most commonly this was a ventricular septal defect and tetralogy of Fallot. Seventy-one percent had positive blood cultures. Streptococcus viridans and Staphylococcus aureus were most commonly isolated. Twenty-two percent of the children had undergone previous cardiac surgery. One case closely followed cardiac surgery and in only nine children could a definite port of entry of infection be demonstrated.     

Brain abscess in childhood: a 28-year experience

Brain abscess is an uncommon intracranial suppurative infectious disease, especially in children. The clinical presentation, treatment and outcome of 75 children with brain abscesses admitted to the Department of Pediatric Infectious Diseases at Hacettepe University Faculty of Medicine were retrospectively analyzed. Seventy-five cases of brain abscess within a 28-year period were included in this study. Fever and headache were the most common presenting symptoms. Cyanotic congenital heart disease was the most common predisposing factor. The most common pathogen was Streptococcus spp. Although congenital heart disease remained the most common predisposing factor for development of intracerebral abscess, the rate of immunocompromised diseases as a predisposing factor of brain abscess has increased in recent years, and better management of otogenic infections also influences the prevalence of the disease.     

Infective endocarditis in children. Apropos of 13 cases

From 1978 through 1987, thirteen pediatric patients aged 14/12 years to 16/12 years were hospitalized for infective endocarditis (IE). Ten cases presented as acute septicemia with modification or development of a murmur and/or heart failure. Three patients had subacute endocarditis. Prior to the endocarditis, ten patients had recognized heart disease, whereas three had no known cardiac abnormality. The organism was recovered in seven cases, from blood cultures in six cases (3 Staphylococcus aureus, 1 group D streptococcus, 1 Staphylococcus albus, and 1 Salmonella typhi) and from a prosthesis in one case (Corynebacterium). Echocardiography confirmed the diagnosis in every patient except the one that had a prosthesis. Although all the patients received parenteral antimicrobial therapy, selected according to bacteriologic data when available, complications developed in every case, including heart failure in nine patients. Three children died, eight underwent valve replacement or repair once the infection was under control, and two have residual valvular disease. This study confirms that, in pediatric patients, the prognosis of IE remains severe despite advances in antimicrobial therapy and the contribution of echocardiography.     

A 28-year trend of infective endocarditis associated with congenital heart diseases: A single institute experience

BACKGROUND: Infective endocarditis (IE) is still one of the major complications of congenital heart disease and, therefore, prevention has always been an important issue. But there has been no large scale investigation of IE in Japan. METHODS: Clinical and microbiological features in 183 patients with congenital heart diseases complicated with infective endocarditis (IE), which were treated in our institute in the last 28 years, were reviewed. RESULT: During the period, the age distribution of the patients shifted to an older age; 80% were older than 15 years in the latest 7 year period. In the underlying diseases more complex conditions increased, such as the post Rastelli operation. Dental or oral diseases were the major preceding events and Streptococcus was the major pathogen throughout the study periods in the data. CONCLUSION: The result indicates the importance of continuing education for the prevention of IE and oral hygiene especially in adult patients with a risk for IE.