中国儿童侵袭性肺炎球菌病不良结局的临床特征和危险因素。

Clinical characteristics and risk factors for poor outcomes of invasive pneumococcal disease in pediatric patients in China.

机构信息

Department of Medical Engineering, Qilu Hospital of Shandong University, Jinan, Shandong Province, China.

Department of Pediatrics, Qilu Hospital of Shandong University, No.107 West Wenhua Road, Jinan, 250012, Shandong Province, China.

出版信息

BMC Infect Dis. 2024 Jun 19;24(1):602. doi: 10.1186/s12879-024-09493-9.

DOI:10.1186/s12879-024-09493-9

PMID:38898407

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11186143/

Abstract

BACKGROUND

Invasive pneumococcal disease (IPD) is a significant health concern in children worldwide. In this study, we aimed to analyze the clinical features, antibiotic resistance, and risk variables for poor outcomes in patients with IPD in Hangzhou.

METHODS

A retrospective single-centre study was performed using the pediatric intensive care (PIC) database from 2010 to 2018. The clinical characteristics, laboratory data, antimicrobial resistance, and risk factors for in-hospital mortality and sepsis in patients with IPD in intensive care units (ICUs) were analyzed systematically.

RESULTS

A total of 178 IPD patients were included in the study. The majority of the IPD children were 2-10 years old. Antimicrobial resistance tests of S. pneumoniae isolates revealed high resistance to erythromycin, tetracycline and compound sulfamethoxazole (SMZ-Co). All the isolates were sensitive to vancomycin, linezolid, moxifloxacin, telithromycin, ofloxacin, and levofloxacin. IPD patients may experience poor outcomes, including death and sepsis. The in-hospital mortality was 3.93%, and 34.27% of patients suffered from sepsis. Temperature (OR 3.80, 95% CI 1.62-8.87; P = 0.0021), Partial Pressure of Oxygen in Arterial Blood (PaO) (OR 0.99, 95% CI 0.98-1.00; P = 0.0266), and albumin (OR 0.89, 95% CI 0.80-0.99; P = 0.0329) were found to be independent risk factors for sepsis in children with IPD.

CONCLUSION

Pediatric IPD deserves attention in China. Appropriate surveillance and antibiotic selection are crucial in managing resistant strains. Early identification of high-risk individuals with risk factors contributes to the development of appropriate treatment strategies.

摘要

背景

侵袭性肺炎球菌病（IPD）是全球儿童面临的重大健康问题。本研究旨在分析杭州地区儿童 IPD 的临床特征、抗生素耐药性以及不良预后的风险变量。

方法

采用回顾性单中心研究，利用 2010 年至 2018 年儿科重症监护（PIC）数据库。系统分析了重症监护病房（ICU）中 IPD 患儿的临床特征、实验室数据、抗生素耐药性以及院内死亡和脓毒症的危险因素。

结果

本研究共纳入 178 例 IPD 患儿，其中大多数为 2-10 岁儿童。肺炎链球菌分离株的药敏试验显示，对红霉素、四环素和复方磺胺甲噁唑（SMZ-Co）具有高度耐药性。所有分离株均对万古霉素、利奈唑胺、莫西沙星、替考拉宁、氧氟沙星和左氧氟沙星敏感。IPD 患儿可能出现不良预后，包括死亡和脓毒症。院内死亡率为 3.93%，34.27%的患者发生脓毒症。体温（OR 3.80，95%CI 1.62-8.87；P=0.0021）、动脉血氧分压（PaO）（OR 0.99，95%CI 0.98-1.00；P=0.0266）和白蛋白（OR 0.89，95%CI 0.80-0.99；P=0.0329）是儿童 IPD 发生脓毒症的独立危险因素。