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。     

儿童脑脊液培养阳性43例临床分析

目的 了解脑脊液培养在儿童细菌性脑膜炎（bacterial meningitis,BM）中的诊治价值.方法 对我院2008年1月至2012年12月脑脊液培养阳性患儿的临床特点、病原菌种类及实验室检查、治疗经过以及疾病转归进行分析.结果 脑脊液培养阳性病例共43例,13例被确诊为BM.分离出最多的病原菌是凝固酶阴性葡萄球菌（51.2％,22/43）,其中伴有脑脊液常规、生化检查结果异常者仅1例,所有血培养均为阴性,未更换为药敏试验提示的敏感抗生素治疗,患儿均治愈.分离出无乳链球菌4株、肺炎链球菌2株及革兰阴性杆菌4株,所有病例均有脑脊液常规异常,大多数伴有脑脊液生化异常及血培养阳性.结论 脑脊液中分离出的凝固酶阴性葡萄球菌多为污染菌.无乳链球菌、肺炎链球菌及革兰阴性杆菌的检出对BM诊断意义大.BM的诊断一定要结合脑脊液培养、常规、生化及血培养等结果及临床表现综合分析,可避免不必要地使用抗菌药物.     

儿童恶性血液病化疗期间并发感染性休克9例临床分析

目的探讨儿童恶性血液病化疗期间并发感染性休克的临床特征及预后。方法研究对象为2007-01-01—2010-07-01中山大学孙逸仙纪念医院儿科血液肿瘤区化疗期间发生感染性休克患儿9例。分析患儿发生感染性休克临床特点、实验室检查资料、治疗及死亡高危因素。结果 9例患儿1例放弃治疗,5例死亡,3例治愈,病死率62.5%(5/8)。全部患儿白细胞(WBC)计数<1×109/L,革兰阴性杆菌感染5例,阳性率55.6%(5/9)。粪培养示,革兰阴性乙型副伤寒沙门菌感染1例。双肺感染5例(55.6%),胃肠道感染2例,外周静脉置入中心静脉导管处皮肤感染1例,部位不明感染1例。死亡5例中3例肺部感染,3例多器官功能衰竭。结论血液病患儿感染性休克病原菌以革兰阴性杆菌多见,尤以铜绿假单胞菌居多。化疗期间中性粒细胞低下、严重肺部感染、多器官功能衰竭可能是导致休克及死亡的高危因素,早期、足量、高效广谱抗生素,加强支持疗法对减少病死率具有重要意义。     

医院深部真菌感染患儿死亡危险因素分析

目的探讨导致深部真菌感染患儿死亡的危险因素,以利临床医师提高对其认识,降低相关病死率。方法2000年1月～2005年12月住院患儿中确诊深部真菌感染41例,运用回顾性病例对照研究策略,以患儿入院日为研究起点,死亡或出院为终点。研究因素包括性别、原发病、感染部位、病原菌类型、并发症、治疗措施等16个变量。建立Logistic回归模型,计算校正前后的优势比(OR)及其95%可信区间(CI)。结果41例患儿中19例死亡,占46%。单因素分析显示,医院深部真菌感染患儿死亡因素包括相关粒细胞减少、合并细菌感染、感染性休克、肾功能损害、肝功能损害、心功能不全、胃肠功能不全、低蛋白血症、贫血、抗真菌治疗不及时和广谱抗生素应用。经逐步引入剔除法,建立Logistic回归模型,发现医院深部真菌感染死亡危险因素为:肾功能损害(OR=20.477,95%CI为1.111～377.381)、胃肠功能不全(OR=28.720,95%CI为2.282～361.465)和抗真菌治疗不及时(OR=9.953,95%CI为0.786～125.954)。结论在医院深部真菌感染患儿中,肾功能损害、胃肠功能不全和抗真菌治疗不及时是预后不良的危险因素。     

儿童感染性心内膜炎临床特点变化及病原学变迁

目的分析儿童感染性心内膜炎临床特点变化及病原菌的变迁，为临床诊治提供进一步指导。方法回顾分析10年中我院73例14岁以下儿童感染性心内膜炎患儿外科手术的临床资料。并将1995年1月-1999年12月的32例（Ⅰ组）与2000年1月-2004年12月的41例（Ⅱ组）做统计学分析对比，比较两组病例临床特点的变化及病原菌的变迁。结果73例患儿占同期同年龄组住院患儿总数的7．3％（73／998），Ⅱ组的比例（41／671，6．1％）低于Ⅰ组（32／327，9．8％，P〈0．05）。66例有基础心脏病，其中室间隔缺损（VSD）47例，动脉导管未闭（PDA）15例，其他4例。心脏赘生物的检出率，Ⅱ组的比例（27／41，65．9％）高于Ⅰ组（15／32，46．9％，P〈0．01）。59例血细菌培养阳性，14例血细菌培养阴性。总的细菌培养阳性率为73．9％（54／73），Ⅰ组为96．88％（31／32），Ⅱ组为68．29％（28／41）。心脏赘生物的检出率增高，由Ⅰ组的46．9％（15／32）增高为Ⅱ组为65．9％（27／41）。儿童IE的病原菌菌谱发生明显变化，革兰阳性球菌的阳性检出率明显减少，而革兰阴性杆菌的检出率明显增加。结论外科治疗的儿童感染性心内膜炎临床特点发生一定变化，血培养的阳性率降低，而心脏赘生物的检出率增高。儿童IE的病原菌菌谱中革兰阴性杆菌所占比例有明显的增高。     

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。     

29例小儿感染性心内膜炎的临床分析

目的：分析小儿感染性心内膜炎(IE)的临床特征。方法：分析该院近10年来收治的29例感染性心内膜炎的患儿。结果：感染性心内膜炎在小儿中发病率较高,占住院病儿的 0.23%,男女比例为2∶1。≤2岁者10例,>2岁者19例。两组患儿在病原学和预后方面表现出显著差异。先天性心脏病是22例患儿的易患因素。金黄色葡萄球(13例)和草绿色链球菌(6例)是最常见的病原菌。6例病变存在于修复后的瓣膜上。结论：小儿感染性心内膜炎在治疗方面已经取得很大进展,但它仍为一种严重的疾病。年龄小于2岁、致病菌为金葡菌、经历瓣膜手术是预后不良的主要因素。     

早产儿坏死性小肠结肠炎合并血培养阳性败血症的病例对照研究

目的 研究合并血培养阳性败血症的早产儿坏死性小肠结肠炎(necrotizing enterocolitis,NEC)的临床资料及预后情况,为临床更好的诊断、治疗及减少病死率提供参考.方法 对深圳市宝安区妇幼保健院NICU 2007年1月至2015年12月确诊Ⅱa以上NEC合并血培养阳性败血症的25例患儿的临床资料进行回顾性分析,并按1∶1比例随机选取同期确诊为单纯Ⅱa以上的NEC患儿25例作为对照组.结果 (1)Ⅱa以上NEC合并血培养阳性败血症组与单纯Ⅱa以上NEC组患儿在胎龄、出生体重、起病年龄、住院时间、并发症及白细胞计数等方面比较差异均无统计学意义(P＞0.05).Ⅱa以上NEC合并血培养阳性败血症组与单纯Ⅱa以上NEC组患儿在超敏CRP＞80mg/L和血小板计数＜50×109/L方面比较差异有统计学意义(P＜0.05).Ⅱa以上NEC合并血培养阳性败血症组死亡或放弃的人数较单纯Ⅱa以上NEC组高,差异有统计学意义(P＜0.05).(2)Ⅱa以上NEC合并血培养阳性败血症组患儿血培养的主要病原菌有肺炎克雷白杆菌、大肠埃希菌、屎肠球菌及粪肠球菌等,其中肺炎克雷白杆菌和大肠埃希菌占50%以上.药敏结果显示,肺炎克雷白杆菌和大肠埃希菌等革兰阴性菌均对环丙沙星、左氧氟沙星及美罗培南敏感.(3)Logistic回归分析结果显示,与Ⅱa以上NEC合并血培养阳性败血症有显著相关性的变量为血小板计数＜50×109/L(OR=3.48,95%CI:1.35~8.68)和男性患儿(OR=2.09,95%CI:1.02~4.85).结论 Ⅱa以上NEC合并血培养阳性败血症患儿预后不良,对可疑患儿,尽早使用有效抗生素治疗,减少病死率.     

儿童急性淋巴细胞白血病中性粒细胞缺乏伴发热单中心血流感染病原菌分析

目的 分析儿童急性淋巴细胞白血病(ALL)化疗后中性粒细胞缺乏伴发热(FN)血流感染的临床特点、危险因素和病原菌分布。方法 回顾性分析2007年1月1日至2016年12月31日上海交通大学附属儿童医院血液肿瘤科收治的ALL化疗后发生FN住院患儿的临床资料和血培养结果,分析菌株的分布及药敏特点。结果 纳入ALL患儿312例,FN1 548例次,共送检1 700例次血培养,血培养阳性率7.5%(127/1 700),血流感染发生率8.2%(127/1 548),病死率9.4%(12/127)。血流感染革兰阳性菌51.1%(65/127),革兰阴性菌47.2%(60/127),真菌1.5%(2/127)。革兰阴性菌血流感染与革兰阳性菌血流感染比较,ANC<0.1×10⁹·L^-1的患儿占比(P=0.041)和感染性休克发生率更高(P=0.002)。2012~2016年铜绿假单胞菌构成比较2007~2011年增加(χ²=4.712,P=0.030)。ALL的危险程度分层IR/HR(OR=2.560,P=0.045)和ANC<0.1×10⁹·L^-1(OR=0.754,P=0.025)是血流感染发生的独立危险因素。结论 ALL患儿发生FN时血流感染病原菌阳性率较高(8.2%),以革兰阳性菌感染为主。在严重粒细胞缺乏时以革兰阴性菌血流感染为主,铜绿假单胞菌感染有增加趋势,合并感染性休克是FN死亡的独立危险因素。     

儿童急性淋巴细胞白血病中性粒细胞缺乏伴发热单中心血流感染病原菌分析

目的 分析儿童急性淋巴细胞白血病(ALL)化疗后中性粒细胞缺乏伴发热(FN)血流感染的临床特点、危险因素和病原菌分布。方法 回顾性分析2007年1月1日至2016年12月31日上海交通大学附属儿童医院血液肿瘤科收治的ALL化疗后发生FN住院患儿的临床资料和血培养结果,分析菌株的分布及药敏特点。结果 纳入ALL患儿312例,FN1 548例次,共送检1 700例次血培养,血培养阳性率7.5%(127/1 700),血流感染发生率8.2%(127/1 548),病死率9.4%(12/127)。血流感染革兰阳性菌51.1%(65/127),革兰阴性菌47.2%(60/127),真菌1.5%(2/127)。革兰阴性菌血流感染与革兰阳性菌血流感染比较,ANC<0.1×10⁹·L^-1的患儿占比(P=0.041)和感染性休克发生率更高(P=0.002)。2012~2016年铜绿假单胞菌构成比较2007~2011年增加(χ²=4.712,P=0.030)。ALL的危险程度分层IR/HR(OR=2.560,P=0.045)和ANC<0.1×10⁹·L^-1(OR=0.754,P=0.025)是血流感染发生的独立危险因素。结论 ALL患儿发生FN时血流感染病原菌阳性率较高(8.2%),以革兰阳性菌感染为主。在严重粒细胞缺乏时以革兰阴性菌血流感染为主,铜绿假单胞菌感染有增加趋势,合并感染性休克是FN死亡的独立危险因素。     

小儿感染性心内膜炎治疗的现状

Objective During recent years several changes have occurred in the clinical characteristics of infective endocarditis (IE) which has made a new challenge in the management of this disease. This study aimed to understand current practice pattern in the management of pediatric IE in China. Methods This retrospective, multicenter study was conducted in 13 hospitals. Clinical data of 268 patients diagnosed as IE according to the new IE criteria (trial) between 2000 and 2006 were analysed, focusing particularly on management and outcome of patients. The mean age of patients was 8.94 years (18 d-18 years). Results Except for one patient who died after admission without treatment, 56 antimicrobial agents were used in the management of this disease in the 267 patients, including cephalosporin group (15), penicillin group (8), beta-lactamase inhibitor combination (8), aminoglycosides (4), glycopeptide agents (3) etc. The most commonly used antibiotics were as follows: penicillin G (125 cases/times), cefotaxime (113), vancomycin (78), ceftriaxone (73), ampicillin (66), cefuroxime (56), piracillin (48), amikacin (39) etc. For management of this disease, only one antibiotic agent was used in 33 (12.3%) patients, two antibiotic agents in 83 (31.1%) patients, 3 antibiotic agents in 44 (16.5 %) patients, 4 antibiotic agents in 57(21.3%) patients, 5 antibiotic agents in 25(9.4%) patients, 6 or more antibiotic agents in 25 (9.4%) patients. The most commonly used antibiotic agents in patients with streptococci detected in blood culture were penicillin G, cephalosporins, vancomycin, beta-lactamase inhibitor combination, and aminoglycoside, in patients with staphylococcus detected in blood culture were cephalosporins, oxicillin, vancomycin, aminoglycoside, and quinolones. Duration of antibiotic treatment was from 1 day to 98 days, less than 2 weeks in 19 (7%) patients, 2 weeks to less than 4 weeks in 74 (27.7%) patients, 4-6 weeks in 122 (45.7%) patients, more than 6 weeks in 52 (19.4%) patients; 123 patients simultaneously underwent surgical management (for removal of vegetations and intracardiac defects or residual shunt repair 105, and valve repair 8, valve replacement 6, intracardiac defect repair 4) .Of the 268 patients, 186 patients were cured, 4 patients were referred to surgery, 18 patients died and 60 patients refused medical advice. In antibiotics and surgical treatment group (123 patients), 111 patients were cured, 4 patients were referred to surgery, 5 patients died, 3 patients refused medical advice, in antibiotics treatment group (145 patients), 75 patients were cured, 13 patients died, 57 patients refused medical advice. The outcomes were significantly different between the two groups (χ2=61.7, P=0.000). The results of multivariate logistic regression analysis showed that Staphylococcus aureus as a pathogen (χ2=4.40,P=0.036,OR=9.78,95% CI 1.16-82.26), children with repaired congenital heart disease (χ2=9.4,P=0.002,OR=9.8,95% CI 2.28-42.16), and complicated with heart failure (χ2=10.36,P=0.001, OR=0.075,95% CI 0.16-0.36) were risk factors related to death. Conclusion This study revealed the current status in the management of pediatric IE in China. Wide range antibiotic agents and diverse regimens are used to manage children with IE. For improving management of pediatric IE, there is an urgent need for guidelines or recommendations or consensus for management of pediatric IE stipulated by multidiscipline specialists, and randomized controlled clinical trials are required to provide evidences.     

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.     

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??Objective To explore the clinical features of infective endocarditis and the factors related to efficacy. Methods The clinical data of 33 patients with infective endocarditis admitted to our hospital from november 2013 to november 2015 were retrospectively analyzed??including the pathogenic characteristics??underlying diseases??vegetation distributions??treatment program and prognosis. Results The pathogen detection rate of those cases was 75.76%??and the rate of being with underlying disease was 93.94%. The vegetation laid mainly in the heart valves??63.64%????followed by implant artificial material??the impact place of residual shunt and blood flow. For all the cases??the combination of the surgery with the full course of antibiotic therapy had good effect. Conclusion The positive blood culture in patients of infective endocarditis is high. The disease is more common in children with basic heart diseases. The combination of the early radical surgery and the full course of antibiotic therapy are the key to the treatments.     

儿童感染性心内膜炎33例临床特点及疗效分析

目的 探讨儿童感染性心内膜炎的临床特点及影响疗效的因素。方法 回顾性研究2013年11月至2015年11月上海儿童医学中心心内科诊断并治疗的33例感染性心内膜炎患儿的临床资料,分析其病原学特点、心脏基础疾病、赘生物分布特点、治疗方案及预后情况。结果 感染性心内膜炎病原菌的检出率为75.76%。具有先天性心脏基础疾病的比例为93.94%。赘生物主要位于反流的瓣膜,占63.64%,其次为植入的人工材料、缺损处分流及血流冲击处等。手术结合足疗程的抗感染治疗效果较好。结论 感染性心内膜炎的血培养阳性率高,且多发生于具有心脏基础疾病的患儿。早期彻底的手术治疗联合全程抗感染治疗是治疗感染性心内膜炎的关键。     

Complications and outcome in left-sided endocarditis in children

We retrospectively assessed the clinical course and outcome of left-sided endocarditis in pediatric patients to find out the prognostic significance of the presence and size of echocardiographically detected vegetations. Among the children admitted to our institution with endocarditis between January 1987 and October 1999, 16 patients (mean age 9.03 +/- 4.95 years) who met the Duke criteria for the diagnosis of infective endocarditis (IE) were included in this study. Rheumatic valvular disease was the most frequent underlying heart disease (10 patients: 62.5%). Five patients were operated at a mean of 13.9 months before endocarditis, and all had residual defects. Vegetation was detected in 11 cases (69%). Ten patients had major complications (within 2 weeks in 6 patients). Three patients developed congestive heart failure (CHF), six had intracranial and one had lower extremity emboli. Among them four were operated because of complications (CHF: 3 cases, intracranial emboli: 1 case). All the operated cases are doing well. The association between intracranial embolic events and echocardiographically detected vegetations was determined by calculating specificity (40%), sensitivity (100%), positive predictive value (50%), and negative predictive value (100%). No intracranial embolism occurred in patients without vegetations. All vegetations were < or = 6 mm in patients with systemic embolism. There were four deaths, three of which were because of intracranial embolism. This study suggests that intracranial emboli have a major risk of mortality in left-sided endocarditis. The larger size of the vegetation is not a predictor of complications; furthermore, the absence of vegetations predicts that the patient is safe from embolic events. Therefore all patients with left-sided IE should be considered for earlier surgical intervention.     

The impact of the central venous catheter on the diagnosis of infectious endocarditis using Duke criteria in children with Staphylococcus aureus bacteremia

BACKGROUND: Infective endocarditis (IE) is a known complication of Staphylococcus aureus bacteremia in pediatric patients. We sought to evaluate the impact of prolonged bacteremia associated with a retained central venous catheter (CVC) in the diagnosis of IE using Duke criteria. METHODS: We conducted a 13-year retrospective review of hospitalized patients with blood cultures positive for S. aureus from 1993 to 2005. Subjects were identified from the microbiology database and medical records. To identify patients with IE we retrospectively applied the Duke criteria by recording the number of positive blood cultures, time to sterilization, presence of congenital heart disease, fever >38.5 degrees C, and echocardiographic findings. RESULTS: During the study period, 344 events of S. aureus bacteremia were identified in 316 pediatric patients. S. aureus bacteremia attributable mortality was 1.7% (n = 6), all among patients with comorbid conditions. By applying the Duke criteria to the 206 (60%) patients who received echocardiographic evaluation, 78 (37.9%) patients were given a diagnosis of IE (7 definite; 71 possible). The incidence of definite IE in patients with CVC is 3.4% and the incidence in patients without CVC is 3.4% (P = 0.6305). The incidence of possible IE in patients with CVC is 42.9%, whereas the incidence in patients without CVC is 23% (P = 0.002). CONCLUSIONS: Evaluation for IE is inconsistently done. The presence of a CVC may skew the diagnosis of IE by prolonging the bacteremic state. We believe that a major microbiologic criteria should not be assumed unless cultures remain positive after removal of CVC.     

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.     

婴儿吸入性肺炎危险因素的病例对照研究

目的 分析婴儿吸入性肺炎的危险因素。方法 纳入2016年1月至2018年12月因肺炎在复旦大学附属儿科医院（我院）住院，入院前在我院门诊或入院后完成唾液吸入显像检查的患儿，根据检查结果分为病例组（吸入性肺炎）和对照组（非吸入性肺炎），回顾性收集临床资料，比较两组临床特征，分析婴儿吸入性肺炎的危险因素。结果 484例患儿进入本文分析，病例组151例，对照组333例。两组既往肺炎病史、呛奶、病原学检测阳性、伴有神经系统疾病、上气道疾病、下气道结构异常、遗传综合征差异均具有统计学意义。Logistic回归分析结果显示病原学检测阳性（OR=2.033,95%CI: 1.261~3.279）、伴有神经系统疾病（OR=2.210，95%CI: 1.318~3.707）、上气道疾病（OR=2.408，95%CI: 1.556~3.727）、遗传综合征（OR=2.909，95%CI: 1.265~6.692）是婴儿吸入性肺炎的独立危险因素。结论 病原学检测阳性、伴有神经系统疾病、上气道疾病、遗传综合征是婴儿吸入性肺炎的危险因素。     

婴儿吸入性肺炎危险因素的病例对照研究

目的 分析婴儿吸入性肺炎的危险因素。方法 纳入2016年1月至2018年12月因肺炎在复旦大学附属儿科医院（我院）住院,入院前在我院门诊或入院后完成唾液吸入显像检查的患儿,根据检查结果分为病例组（吸入性肺炎）和对照组（非吸入性肺炎）,回顾性收集临床资料,比较两组临床特征,分析婴儿吸入性肺炎的危险因素。结果 484例患儿进入本文分析,病例组151例,对照组333例。两组既往肺炎病史、呛奶、病原学检测阳性、伴有神经系统疾病、上气道疾病、下气道结构异常、遗传综合征差异均具有统计学意义。Logistic回归分析结果显示病原学检测阳性（OR=2.033,95%CI: 1.261~3.279）、伴有神经系统疾病（OR=2.210,95%CI: 1.318~3.707）、上气道疾病（OR=2.408,95%CI: 1.556~3.727）、遗传综合征（OR=2.909,95%CI: 1.265~6.692）是婴儿吸入性肺炎的独立危险因素。结论 病原学检测阳性、伴有神经系统疾病、上气道疾病、遗传综合征是婴儿吸入性肺炎的危险因素。     

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.