儿童金黄色葡萄球菌脓毒症抗生素治疗现状分析

Current status of antibiotic therapy for Staphylococcus aureus sepsis in children

摘要:

目的 回顾性分析金黄色葡萄球菌脓毒症患儿经验性抗生素治疗现状，探讨治疗模式对其预后的影响。方法 将2014年1月至2017年8月收治的78例金黄色葡萄球菌脓毒症患儿，依据血培养报告金黄色葡萄球菌生长前经验性首选抗生素治疗类型分为碳青霉烯类治疗组（n=16）、β-内酰胺类治疗组（n=37）、万古霉素治疗组（n=15）、万古霉素+β-内酰胺类治疗组（n=10）。收集各组患儿的一般情况、基础疾病、急性生理功能与慢性健康状况评分系统Ⅱ（APACHE Ⅱ）、免疫抑制剂使用史、甲氧西林耐药性及预后资料，进行回顾性分析。采用logistic回归探讨经验性抗生素治疗方案对金黄色葡萄球菌脓毒症患儿临床疗效及预后的影响。结果 各组患儿一般情况、基础疾病、免疫抑制剂使用史、APACHE Ⅱ评分、院内感染、MRSA检出率比较差异无统计学意义（P > 0.05）。四组间脓毒性休克、院内死亡率比较差异有统计学意义（P < 0.05），其中碳青霉烯类治疗组脓毒性休克、院内死亡率均最高（分别为69%、50%）。多因素logistic回归分析结果提示，经验性抗生素治疗类型是金黄色葡萄球菌脓毒症患儿发生脓毒性休克和院内死亡的独立危险因素（P < 0.05）；APACHE Ⅱ评分≥ 15是金黄色葡萄球菌脓毒症患儿发生脓毒性休克的独立危险因素（P < 0.05）；与使用万古霉素治疗组相比，碳青霉烯类治疗组发生脓毒性休克和院内死亡的风险高（P < 0.05）。结论 不恰当的经验性使用抗生素治疗可能导致儿童金黄色葡萄球菌脓毒症预后不佳。临床疑诊金黄色葡萄球菌脓毒症患儿，不建议经验性使用碳青霉烯类抗菌药物治疗。

Abstract:

Objective To investigate the current status of empirical antibiotic therapy for children with Staphylococcus aureus sepsis and the effect of therapeutic paradigm on prognosis based on a retrospective analysis. Methods A total of 78 children with Staphylococcus aureus sepsis who were admitted from January 2014 to August 2017 were enrolled. According to the preferred empirical antibiotics before the detection of Staphylococcus aureus by blood culture, these children were divided into a carbapenem group with 16 children, a β-lactam group with 37 children, a vancomycin group with 15 children and a vancomycin+β-lactam group with 10 children. A retrospective analysis was performed for related clinical data including general status, underlying diseases, Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) score, history of use of immunosuppressant, drug resistance to methicillin and prognosis. A logistic regression analysis was used to investigate the effect of empirical antibiotic therapy on the clinical outcome and prognosis of children with Staphylococcus aureus sepsis. Results There were no significant differences among these groups in general status, underlying diseases, history of use of immunosuppressant, APACHE Ⅱ score, nosocomial infection and detection rate of methicillin-resistant Staphylococcus aureus (P > 0.05). There were significant differences in the incidence rate of septic shock and in-hospital mortality among these four groups (P < 0.05). The carbapenem group had the highest incidence rate of septic shock and in-hospital mortality (69% and 50% respectively). The multivariate logistic regression analysis showed that empirical antibiotic therapy with different antibiotics had different risks for septic shock and in-hospital death in children with Staphylococcus aureus sepsis (P < 0.05), and that an APACHE Ⅱ score of ≥ 15 was an independent risk factor for septic shock in these children (P < 0.05). The carbapenem group had significantly higher risks of septic shock and in-hospital death than the vancomycin group (P < 0.05). Conclusions Inappropriate empirical use of antibiotics may lead to a poor prognosis in children with Staphylococcus aureus sepsis. Empirical use of carbapenems is not recommended for children suspected of Staphylococcus aureus sepsis.