PICU社区获得性细菌性血流感染病原分布及临床特点分析

目的 探讨PICU社区获得性细菌性血流感染病原与疾病特点的相关性.方法 回顾性分析2011年6月至2016年6月所有入住中国医科大学附属盛京医院PICU诊断为脓毒症患儿的临床资料,筛选出符合社区获得性细菌性血流感染的病例资料进行分析.结果 符合社区获得性细菌性血流感染患儿共191例,其中男108例,女83例.36个月以内婴幼儿167例(87.4%),50例(26.2%)有基础疾病,休克40例(20.9%),其中脓毒性休克33例.病原菌中革兰阳性菌为主要致病菌(73.3%, 140/191).191例患儿中死亡41例(21.5%),肺炎链球菌为社区获得性细菌性血流感染的首要致病菌(19.9%,38/140).结论 PICU社区获得性细菌性血流感染患儿多集中于36个月以内婴幼儿,革兰阳性菌为主要致病菌,最常见的5类细菌为肺炎链球菌、表皮葡萄球菌、金黄色葡萄球菌、化脓性链球菌及大肠杆菌.所有病原中,铜绿假单胞菌感染所致患儿病死率最高,合并基础疾病、休克及应用机械通气治疗是患儿死亡的高危因素.

Community-acquired bacteria bloodstream sepsis in children:Analysis of pathogens and clinical characteristics in PICU

Objective To explore the relationship between pathogen and disease characteristics of community-acquired bacterial bloodstream sepsis in PICU.Methods The clinical data of children diagnosed as sepsis admitted to the PICU of Shengjing Hospital of China Medical University between June 2011 and June 2016 were retrospectively analyzed.Medical records were screened to confirm the diagnosis of commu-nity-acquired bacteria bloodstream sepsis.Results One hundred and ninety-one children(108 males and 83 females) had confirmed community-acquired bacteria bloodstream sepsis with the following characteristics:167 patients(87.4%) with the age less than 36 months,50 patients(26.2%) with co-existing disease,40 pa-tients(20.9%) with shock,of which 33 patients had septic shock,and 41 patients(21.5%) died.Gram-posi-tive bacteria was the predominant pathogen(73.3%,140/191).Streptococcus pneumoniae was the primary pathogen(19.9%,38/140). Conclusion Community-acquired bacteria bloodstream sepsis in PICU most commonly affects children less than 36 months of age.Gram-positive bacteria are the predominant pathogenic bacteria,the most common pathogens are Streptococcus pneumoniae,Staphylococcus epidermidis,Staphylo-coccus aureus,Streptococcus pyogenes and Escherichia coli.The highest mortality rate in septic children is caused by Pseudomonas aeruginosa.Children with co-existing disease,sepsis complicated with shock and pa-tients requiring mechanical ventilation are risk factors for death.