侵袭性化脓性链球菌感染危重症患儿的治疗决策——从1例病例引出的思考

摘要：目的 了解儿童危重症侵袭性化脓性链球菌感染的临床特点和诊治措施。方法 回顾性分析我院1例严重侵袭性化脓性链球菌感染患儿的诊治过程，并对相关文献进行综述。 结果 结合患儿高热、咳嗽、胸痛、有胸腔积液、外周血炎症指标高和入院后迅速出现休克的临床特点，予抗休克、气管插管呼吸机辅助通气和血液净化治疗。入院后胸水培养化脓性链球菌生长，菌株对青霉素、头孢曲松敏感。患儿先后经包含头孢曲松、万古霉素、利奈唑胺和美罗培南的方案进行抗感染治疗，住院36 d好转出院。本例抗生素使用种类多、更换频繁与既往对本病的多中心研究结果一致。结论 儿童侵袭性化脓性链球菌感染症状危重，恢复较慢，导致临床抗生素更换较为频繁，青霉素、头孢曲松依旧是推荐本病治疗的首选用药。

Therapeutic strategy for severe invasive Streptococcus pyogenes disease in children——experience from one case

Abstract Objective To know the clinical characteristics of critical invasive Streptococcus pyogenes disease in children. Methods The progress, diagnosis, and treatment of a case of severe invasive Streptococcus pyogenes infection in our hospital were analyzed retrospectively and the related literatures were reviewed. Results According to the clinical manifestation such as high fever, cough, chest pain, pleural effusion, high level of inflammatory indicators in peripheral blood and development into shock after admission, anti-shock, endotracheal intubation ventilator assisted ventilation and blood purification were administered. Streptococcus pyogenes was cultured in pleural fluid and it was sensitive to penicillin and ceftriaxone. Anti-infection regimen including monotherapy with ceftriaxone, or vancomycin, or linezolidine, or meropenem, or more than two antibiotics in combination was used, the child was recovered and discharged after hospitalization for 36 days. Variety and frequent replacement of antibiotics for therapy in this case was consistent with that of previous multi-center studies on this disease in China. Conclusion The symptoms of invasive streptococcus pyogenic infection in children are critical and the recovery is slow, which leads to frequent change of antibiotics. Penicillin and ceftriaxone are still the important preferred drugs for the treatment of this