French G L, Cheng A F, Duthie R, Cockram C S
Department of Microbiology, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, New Territories.
J Antimicrob Chemother. 1990 Apr;25 Suppl C:115-25. doi: 10.1093/jac/25.suppl_c.115.
In a five-year prospective study of blood culture-positive septicaemia in a Hong Kong teaching hospital there were 2211 clinically-significant episodes, of which 16% occurred in children less than 15 years old. The microbiology and clinical features were broadly similar to those seen in Europe and North America, but with some important differences. Two-thirds of episodes were community-acquired. The most common organism isolated from community-acquired septicaemias was Escherichia coli and the source, most commonly, the urinary tract. However, the biliary tract was the second most common source of community-acquired infection (25%), reflecting the frequency of liver disease in Hong Kong. Three per cent of community-acquired septicaemias were associated with endocarditis; half of these were with viridans streptococci, usually in patients with rheumatic heart disease, and 40% were in drug addicts with methicillin-sensitive Staphylococcus aureus. The commonest organisms causing community-acquired childhood infections were Salmonella spp. (27%) and Streptococcus pneumoniae (22%), whereas pneumococci accounted for only 3% of adult community-acquired micro-organisms. Haemophilus influenzae infections were uncommon and there was no case of meningococcal or gonococcal septicaemia. The commonest cause of hospital-acquired septicaemia was Staph. aureus (24%), of which 46% were methicillin-resistant. The characteristics of septicaemia in Hong Kong are influenced by the patient population structure, endemic disease patterns, local medical practice and socio-economic factors, but the rarity of Str. pneumoniae in adults and of H. influenzae and Neisseria meningitidis in children is unexplained.
在香港一家教学医院对血培养阳性败血症进行的一项为期五年的前瞻性研究中，有2211例具有临床意义的病例，其中16%发生在15岁以下儿童中。微生物学和临床特征与欧洲和北美所见大致相似，但存在一些重要差异。三分之二的病例是社区获得性的。从社区获得性败血症中分离出的最常见病原体是大肠杆菌，最常见的感染源是尿路。然而，胆道是社区获得性感染的第二大常见来源（25%），这反映了香港肝病的发病率。3%的社区获得性败血症与心内膜炎有关；其中一半与草绿色链球菌有关，通常发生在风湿性心脏病患者中，40%发生在对甲氧西林敏感的金黄色葡萄球菌感染的吸毒者中。引起社区获得性儿童感染的最常见病原体是沙门氏菌属（27%）和肺炎链球菌（22%），而肺炎球菌仅占成人社区获得性微生物的3%。流感嗜血杆菌感染并不常见，没有脑膜炎球菌或淋球菌败血症病例。医院获得性败血症最常见的原因是金黄色葡萄球菌（24%），其中46%对甲氧西林耐药。香港败血症的特征受患者人群结构、地方病模式、当地医疗实践和社会经济因素影响，但成人中肺炎链球菌罕见以及儿童中流感嗜血杆菌和脑膜炎奈瑟菌罕见的原因尚不清楚。
