Totapally B R, Walsh W T
Department of Pediatrics, Hurley Medical Center, Flint, Mich, USA.
Chest. 1998 May;113(5):1207-14. doi: 10.1378/chest.113.5.1207.
To review the clinical and laboratory findings in children with pneumococcal bacteremia during a 6-year period between 1989 and 1995.
Retrospective review of medical records identified from computer-generated blood culture records.
Hurley Medical Center in Flint, Mich, a community teaching hospital affiliated with Michigan State University.
Data concerning age, gender, race, clinical findings, laboratory features, nature of antibiotic therapy, source of bacteremia, and outcome were obtained from patient medical records.
Most (68%) of the children with pneumococcal bacteremia were <2 years of age. About 50% of the cases of invasive pneumococcal disease in childhood occurred between February and May. Focal source of bacteremia was as follows: 11.5% had meningitis, 37% had pneumonia, 30% had otitis media, and 33% had no focal source. Overall, 60% of children were African-Americans, although in children with meningitis, whites were predominant (p<0.04). Leukocytosis was present in 81% and bandemia >1,500/microL was present in 53% of children. The overall mortality was 1.6% with a case fatality rate for meningitis of 14%. Penicillin resistance was found in 6.5% of pneumococcal isolates, although during 1 study year (1993), 17% of all pneumococcal isolates from all sources in the same hospital were found to be penicillin resistant.
Clinical and laboratory findings seen in children with pneumococcal bacteremia at a community hospital are presented with a review of literature. Pneumococci isolated from sterile body sites were found to be less resistant to antibiotics compared with those isolated from nonsterile body sites.
回顾1989年至1995年这6年间肺炎球菌菌血症患儿的临床及实验室检查结果。
对通过计算机生成的血培养记录识别出的病历进行回顾性研究。
密歇根州弗林特市的赫尔利医疗中心，这是一家隶属于密歇根州立大学的社区教学医院。
从患者病历中获取有关年龄、性别、种族、临床检查结果、实验室特征、抗生素治疗性质、菌血症来源及转归的数据。
大多数（68%）肺炎球菌菌血症患儿年龄小于2岁。儿童侵袭性肺炎球菌疾病约50%的病例发生在2月至5月之间。菌血症的病灶来源如下：11.5%有脑膜炎，37%有肺炎，30%有中耳炎，33%无病灶来源。总体而言，60%的患儿为非裔美国人，不过在患脑膜炎的患儿中，白人占多数（p<0.04）。81%的患儿存在白细胞增多，53%的患儿杆状核细胞增多>1500/μL。总体死亡率为1.6%，脑膜炎的病死率为14%。在6.5%的肺炎球菌分离株中发现了青霉素耐药性，不过在1个研究年度（1993年），同一家医院所有来源的肺炎球菌分离株中有17%被发现对青霉素耐药。
本文呈现了一家社区医院肺炎球菌菌血症患儿的临床及实验室检查结果，并对相关文献进行了综述。与从非无菌身体部位分离出的肺炎球菌相比，从无菌身体部位分离出的肺炎球菌对抗生素的耐药性较低。
