| 摘要: |
| 目的:探讨儿童耐甲氧西林葡萄球菌(MRS)血流感染的相关危险因素。方法:回顾性分析2020 年1 月至2022 年8 月我
院儿科收治的223 例葡萄球菌血流感染患儿的临床资料,根据药敏试验结果分为MRS 组85 例和甲氧西林敏感葡萄球菌(MSS)
组138 例,分析MRS 血流感染的临床特征及危险因素。将MRS 组患儿按照临床预后分为预后不良组24 例和预后良好组61
例,分析MRS 预后不良的因素。结果:儿童葡萄球菌血流感染以金黄色葡萄球菌和凝固酶阴性葡萄球菌为主,MRS 分离率为
38. 12%(85/ 223)。单因素及多因素Logistic 回归分析显示,感染性休克(OR=2. 282)、气管插管(OR=1. 960)、使用抗真菌药物
(OR=2. 067)、血流感染前抗菌药物≥3 种(OR=2. 116)和血流感染前激素用药>5 d(OR=2. 468)是儿童MRS 血流感染的独立
危险因素(P<0. 05);意识障碍(OR=3. 056)、降钙素原(PCT)>10 ng/ mL(OR=2. 810)、血清乳酸>2. 0 mmol/ L(OR=3. 618)、感
染性休克(OR=4. 623)、凝血功能障碍(OR=2. 569)和多器官功能障碍≥3 个(OR=4. 956)是儿童MRS 血流感染预后不良的独
立危险因素(P<0. 05)。结论:临床医师应尽早识别、有针对性采取预防措施和优化治疗方案,控制MRS 产生,以降低MRS 血流
感染的病死率和预后不良率。 |
| 关键词: 耐甲氧西林葡萄球菌 血流感染 儿童 预后 危险因素 |
| DOI：doi:10.13407/j.cnki.jpp.1672-108X.2024.04.010 |
|
| 基金项目:河北省医学科学研究计划项目,编号20220463。 |
|
| Clinical Characteristics and Prognostic Factors of Methicillin-Resistant Staphylococcus BloodstreamInfection in Children |
| Cao Mingyue, Li Wanhui, Chen Hejun, Lyu Xiaoqian, Yan Ping |
| ((Hengshui People’s Hospital, Hebei Hengshui 053000, China)) |
| Abstract: |
| Objective: To investigate the clinical characteristics and prognostic factors of methicillin-resistant Staphylococcus (MRS)
bloodstream infection in children. Methods: Clinical data of 223 children with Staphylococcus bloodstream infection admitted into the
pediatrics of our hospital from Jan. 2020 to Aug. 2022 were retrospectively analyzed, and all patients were divided into 85 cases of MRS
group and 138 cases of methicillin-sensitive Staphylococcus (MSS) group according to drug sensitivity results. Clinical characteristics and
risk factors of bloodstream infection with MRS were analyzed. According to clinical prognosis, MRS patients were divided into poor
prognosis group (n =24) and good prognosis group (n = 61). Risk factors of poor prognosis with bloodstream infection by MRS were
analyzed. Results: The main strains of Staphylococcus were Staphylococcus aureus and coagulase negative staphylococci. The isolation
rates of MRS was 38. 12% (85/ 223). Univariate and multivariate Logistic regression analysis showed that septic shock (OR=2. 282),
tracheal intubation (OR=1. 960), use of antifungals (OR= 2. 067), use of antibiotics before bloodstream infection ≥3 kinds (OR=
2. 116) and use of hormones before bloodstream infection >5 d (OR = 2. 468) were independent risk factors for MRS bloodstream infection in children (P<0. 05). Disorders of consciousness (OR= 3. 056), procalcitonin (PCT) >10 ng/ mL (OR= 2. 810), serum
lactate > 2. 0 mmol/ L (OR = 3. 618), septic shock (OR = 4. 623), coagulopathy (OR = 2. 569) and multiple organ dysfunction
syndrome ≥3 kinds (OR=4. 956) were independent risk factors for poor prognosis in children with MRS bloodstream infection (P<
0. 05). Conclusion: Clinicians should identify early, target prophylactic measures and optimize treatment regimens to control MRS in
order to reduce the morbidity, mortality and poor prognosis of MRS bloodstream infection. |
| Key words: methicillin-resistant Staphylococcus bloodstream infection children prognosis risk factors |
