儿科重症监护室铜绿假单胞菌培养阳性患儿临床特征及耐药性分析

Clinical characteristics and drug resistance in children infected with Pseudomonas aeruginosa in the pediatric intensive care unit

摘要:

目的：总结儿科重症监护室铜绿假单胞菌（pseudomonas aeruginosa, PA）培养阳性患儿的临床特征，为临床早期诊断和合理治疗提供依据。方法：回顾性分析62例PA培养阳性患儿临床资料，包括年龄、受累脏器、发热持续时间、住院时间、转归、机械通气时间、基础疾病、死亡情况、培养结果以及药敏试验结果。结果：62例患儿中，<6月患儿25例（40%），2岁以下47例（76%），中位年龄28.8月。27例痰培养或气管插管导管培养1次阳性，3例血培养1次阳性，32例2次以上不同部位（血、痰、气管插管）培养阳性；平均受累脏器2.8个，呼吸系统最常受累，共58人次（94%）；平均发热时间7.3 d；平均住院时间34.2 d。治愈35例（57%），死亡17例（27%）。51例（82%）应用机械通气，平均通气13.4 d。51例有基础疾病（82%）。17例（27%）死亡，平均年龄17.4个月，CRP平均52.6 mg/L，其中14例白细胞升高或正常，3例白细胞降低。PA对临床常用抗生素的敏感性分别为：头孢哌酮/舒巴坦（72.6%）、美洛培南（70.8%）、亚胺培南（49.1%）、头孢他啶（65.1%）、哌拉西林/他唑巴坦（44.3%）。对头孢唑啉、头孢呋辛及头孢噻肟100%耐药。结论：2岁以下婴幼儿PA感染率较高；呼吸系统最易受累；PA感染患儿多患有基础疾病。PA对常用抗生素敏感性不高。

Abstract:

OBJECTIVE: To study the clinical characteristics of Pseudomonas aeruginosa (PA)-positive children in the pediatric intensive care unit, and to provide a basis for early diagnosis and reasonable treatment of PA infection. METHODS: The clinical data of 62 children infected with PA in the pediatric intensive care unit were retrospectively reviewed,including age, affected organs, fever duration, hospital stay duration, mechanical ventilation duration, prognosis, underlying diseases, mortality, culture results and drug sensitivity test results. RESULTS: Of the 62 PA-positive children, 25 (40%) were aged under 6 months and 47 (76%) under 2 years, with a median age of 28.8 months. Twenty-seven showed one positive result for sputum culture or endotracheal tube aspirates culture, 3 showed one positive result for blood culture, and 32 showed more than two positive results for blood, sputum or endotracheal tube aspirates cultures. On average, 2.8 organs were affected in each patient, with the respiratory system involved most frequently (58 patients, 94%). The mean fever duration was 7.3 days and the mean hospital stay duration was 34.2 days. In the 62 patients, 35 (57%) were cured and 17 (27%) died. Mechanical ventilation was administered to 51 patients (82%) for a mean duration of 13.4 days. Fifty-one patients (82%) had underlying diseases. The 17 (27%) children who died had a mean age of 17.4 months and a mean CRP level of 52.6 mg/L; 14 of them had increased or normal white blood cell count, and 3 had a decreased white blood cell count.The antibiotic sensitivity of PA was 72.6% for cefoperazone/sulbactam, 70.8% for meropenem, 49.1% for imipenem, 65.1% for ceftazidime, and 44.3% for piperacillin/tazobactam. There was complete resistance to cephazolin, cefuroxime and cefotaxime. CONCLUSIONS: The children under 2 years are prone to PA infection. Respiratory system involvements are common. Most of children infected with PA suffer from underlying diseases.The sensitivity of PA to common antibiotics is not high.