| 摘要: |
| 目的:探讨儿童侵袭性流感嗜血杆菌感染临床特征及预后。 方法:回顾性分析我院 2010 年 1 月至 2020 年 1 月收治的168 例儿童侵袭性流感嗜血杆菌感染患儿临床资料,包括一般资料、临床表现、实验室检查指标、药敏试验结果及治疗转归情况,比较有无发生化脓性脑膜炎患儿相关临床指标水平。 结果:168 例患儿中,男 100 例,女 68 例,年龄 1. 50(0. 50,3. 50)岁。合并发热症状 164 例,其中高热 78 例。 168 例患儿同时进行血和脑脊液培养 80 例,其中血和脑脊液培养阳性率分别为 27. 50%(22 / 80)和 52. 50%(42 / 80)。 168 例患儿中,培养 164 株菌株完成药敏试验,其中产生 β-内酰胺酶 44 株,氨苄西林耐药 74 例;全部菌株均对美罗培南、左氧氟沙星及头孢曲松敏感。 单一抗菌药物治疗 74 例,两种抗菌药物治疗 46 例,三种及以上抗菌药物治疗 48 例。 所有化脓性脑膜炎患儿中,流感嗜血杆菌培养阳性亚组脑脊液白细胞(WBC)水平高于阴性亚组(P<0. 05)。 化脓性脑膜炎患儿病程、入院时/ 峰值 C 反应蛋白(CRP)及降钙素原(PCT)水平均高于非化脓性脑膜炎患儿(P<0. 05)。 同时,合并化脓性脑膜炎患儿病情好转比例低于未合并患儿(P<0. 05)。 Logistic 回归分析结果显示,入院时/ 峰值 CRP 及 PCT 水平均为化脓性脑膜炎的独立影响因素(P<0. 05)。 结论:儿童侵袭性流感嗜血杆菌感染易引起脑膜炎和肺炎,其中脑膜炎患儿死亡风险更高,预后更差。 同时,可将第三代头孢菌素作为治疗推荐药物。 |
| 关键词: 儿童 流感嗜血杆菌感染 特征 治疗 预后 |
| DOI：10.13407/j.cnki.jpp.1672-108X.2023.09.010 |
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| 基金项目: |
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| Clinical Characteristics and Prognosis of Invasive Haemophilus Influenzae Infection in Children |
| Ding Shuxian, Ai Kui, Bian Junmei |
| (Wuhan Third Hospital, Wuhan 430074, China) |
| Abstract: |
| Objective: To probe into the clinical characteristics and prognosis of invasive Haemophilus influenzae infection in children. Methods: Retrospective analysis was performed on clinical data of 168 children with invasive H. influenzae infection admitted into our hospital from Jan. 2010 to Jan. 2020, including general information, clinical manifestations, laboratory examination parameters, drug sensitivity test results and treatment outcomes. Subsequently, clinical indicators were compared between children with and without purulent meningitis. Results: Among the 168 cases, there were 100 males and 68 females, with the age of 1. 50 (0. 50, 3. 50) years.Fever symptoms were present in 164 cases, with 78 cases of high fever. Blood and cerebrospinal fluid cultures were performed simultaneously in 80 cases, with positive rates of 27. 50% (22 / 80) and 52. 50% (42 / 80), respectively. Out of the 168 cases, drug sensitivity test was completed for 164 strains, and 44 strains produced β-lactamase, and 74 cases were resistant to ampicillin. All strains were sensitive to meropenem, levofloxacin and ceftriaxone. Single antimicrobial therapy was given to 74 cases, dual antimicrobial therapy to 46 cases, and three or more antimicrobial therapy to 48 cases. In all children with purulent meningitis, the level of cerebrospinal fluid white blood cell count (WBC) in H. influenzae culture positive subgroup was higher than that in negative subgroup (P<0. 05). The admission / peak levels of C-reactive protein (CRP) and procalcitonin (PCT) in children with purulent meningitis were higher than those in children without purulent meningitis ( P < 0. 05). Meanwhile, the proportion of improvement in children with purulent meningitis was lower than that without purulent meningitis (P<0. 05). Logistic regression analysis showed that admission / peak levels of CRP and PCT were independent influencing factors for purulent meningitis (P<0. 05). Conclusion: Meningitis and pneumonia are more likely to occur in children with invasive H. influenzae infection, and these children with meningitis possess higher risk of deathand worse prognosis. Additionally , the third generation cephalosporin can be used as the recommended drug for treatment. |
| Key words: children Haemophilus influenzae infection characteristics treatment prognosis |
