Xu Zhufei, Gao Lichao, Xu Dan, Yang Dehua, Chen Zhimin, Wang Yingshuo
Department of Pulmonology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China.
Department of Cardiology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China.
Front Microbiol. 2023 Aug 7;14:1207490. doi: 10.3389/fmicb.2023.1207490. eCollection 2023.
is an opportunistic pathogen associated with prolonged hospital stays and high mortality rates in adults. However, little is currently known about the clinical features of infection in children.
This retrospective case series study included 40 children diagnosed with , confirmed through bacterial cultures or high-throughput sequencing. Antibiotic resistance was assessed through susceptibility testing. The site and clinical manifestations were evaluated for all patients.
The common infection sites were the abdominal cavity, skin and soft tissue, intracranial, and invasive pulmonary, with the abdominal cavity being the most frequently affected. The drug susceptibility test showed 100% sensitivity to ceftriaxone, levofloxacin, chloramphenicol, vancomycin, and linezolid, 92.6% sensitivity to penicillin, 73.3% resistance to erythromycin, and 76.7% resistance to clindamycin. Besides antibiotic therapy, surgical intervention or pus drainage was often necessary. Lung imaging of four patients revealed pulmonary abscesses, nodules, or encapsulated pleura. Two cases yielded positive culture results, while three were identified as positive through high-throughput nucleotide sequencing of pleural effusion.
In children with infection, emphasis should be placed on the risk of pus or abscess formation. In cases of pulmonary abscess and pleural effusion, especially in male children, should be suspected even if the culture is negative. Improvements in high-throughput nucleotide sequencing are required to reduce misdiagnosis rates.
是一种机会致病菌，与成人住院时间延长和高死亡率相关。然而，目前对于儿童感染的临床特征知之甚少。
本回顾性病例系列研究纳入了40例经细菌培养或高通量测序确诊为感染的儿童。通过药敏试验评估抗生素耐药性。对所有患者的感染部位和临床表现进行了评估。
常见感染部位为腹腔、皮肤和软组织、颅内及侵袭性肺部，其中腹腔受累最为频繁。药敏试验显示对头孢曲松、左氧氟沙星、氯霉素、万古霉素和利奈唑胺的敏感性为100%，对青霉素的敏感性为92.6%，对红霉素的耐药率为73.3%，对克林霉素的耐药率为76.7%。除抗生素治疗外，手术干预或脓液引流通常也是必要的。4例患者的肺部影像学检查显示有肺脓肿、结节或包裹性胸腔积液。2例培养结果为阳性，3例通过胸腔积液的高通量核苷酸测序鉴定为阳性。
对于感染的儿童，应重视脓液或脓肿形成的风险。在肺脓肿和胸腔积液的病例中，尤其是男性儿童，即使培养结果为阴性，也应怀疑感染。需要改进高通量核苷酸测序以降低误诊率。
