急性白血病患儿并发耐碳青霉烯类抗生素败血症的临床特点

目的：研究儿童急性白血病发生耐碳青霉烯类抗生素败血症的临床表现特点、病原菌分布、合并其他感染部位、治疗及预后,为临床合理使用抗生素提供参考依据。方法回顾性分析2011年12月至2015年9月在北京儿童医院血液肿瘤中心住院的45例急性白血病合并革兰阴性菌败血症患儿,药敏结果提示碳青霉烯类抗生素耐药,分析其临床资料及药敏试验结果。结果45例患儿均有发热,其中有8例患儿持续发热,37例患儿发热天数为1~27 d,平均(6.1±5.2)d。45例患儿中26例感染发生于中性粒细胞缺乏阶段,中性粒细胞绝对值<0.5×109/L,中性粒细胞缺乏时间2~79 d,平均(15.2±16.2) d。中性粒细缺乏组发热持续时间平均(7.5±5.8)d,不伴中性粒细缺乏组,发热持续时间平均(3.7±2.5)d,两组比较差异有统计学意义( P＝0.011)。45例患儿中有23例同时伴有其他部位感染,感染灶以肺部、消化道、口腔及肛周为主。全部患儿送检血培养标本总量711份,其中耐碳青霉烯类抗生素的耐药菌共162株,耐药菌标本中以铜绿假单胞菌、肺炎克雷伯杆菌、阴沟肠杆菌及大肠埃希菌为主要致病菌。45例中36例抗感染治疗有效,9例抗感染治疗无效(死亡及放弃)。结论耐碳青霉烯类抗生素败血症的革兰阴性菌以铜绿假单胞菌、肺炎克雷伯杆菌、阴沟肠杆菌及大肠埃希菌为主要致病菌。中性粒细胞缺乏是影响抗感染治疗转归的重要因素。

Clinical characteristics in 45 cases of pediatric acute leukemia with septicemia resistant to carbapenem

Objective To explore the clinical presentation,etiology of sepsis,common positions of in-fection and anti-infectious treatment of pediatric acute leukemia with septicemia resistance to carbapenem. Meth-ods A retrospective chart review of all pediatric acute leukemia with septicemia cases of Beijing Children 's Hospital from December 2011 to September 2015 were analyzed. All cases were selected based on the clinical presentation,at least one Gram-negative bacteria positive result of blood culture and were resistant to carbapen-em. The basic clinical characteristics and the results of blood culture and antimicrobial susceptibilities were ana-lyzed. Results All 45 cases with fever,among them 8 cases under went continued fever,The other 37 cases fe-ver days were ( 6. 1 ± 5. 2 ) d. Twenty-six cases had agranulocytosis. Agranulocytosis time from 2 to 79 days, mean days(15. 2 ± 16. 2)d. Significant difference of fever time between agranulocytosis team and non-agranulo-cytosis team was significant(P=0. 011). Twenty-three cases had infection positions among 45 cases. Lung,di-gestive tract,mouth and crissum were the common positions of infection. The quantum of blood culture samples were 711 parts. There were 162 parts resistant to carbapenems. The primary pathogens were pseudomonas aerugi-nosa,klebsiella pneumoniae, enterobacter cloacae and Escherichia coli. Among those 45 cases, 36 cases were cured,9 cases were ineffective treatment. Conclusion Pseudomonas aeruginosa, klebsiella pneumoniae, enter-robacter cloacae and Escherichia coli accounted for the most of G-bacteria infections resistant to carbapenem in our center. The incidence of septicemia was related to the level of granulocyte and duration of agranulocytosis.