儿科血液病患儿医院血流感染分析

目的研究某院儿科血液病患儿并发医院血流感染的临床特点，为临床合理选用抗菌药物控制感染提供依据。方法收集2003年1月-2006年12月在该院儿科住院且资料完整的并发医院血流感染的血液病患儿病历36份，对其所获取病原菌种类及药敏结果进行分析。结果36例患儿诊断为急性白血病者28例，再生障碍性贫血6例，恶性淋巴瘤2例。临床特点：体温≥39℃伴畏寒寒战31例（86．11％），血压下降13例（36．11％），皮肤软组织炎性小肿块9例（25．00％），腹痛、腹泻6例（16．67％），肛周及会阴部红肿伴疼痛6例（16．67％）；表现泌尿道感染1例（2．78%），肺炎8例（22．22％）。发生血流感染时多数患儿外周血中性粒细胞绝对值〈0．5×10^9／L；感染病原菌依次为铜绿假单胞菌、大肠埃希菌、真菌、金黄色葡萄球菌、凝固酶阴性葡萄球菌等。革兰阴性菌对亚胺培南敏感，对氨苄西林和三代头孢菌素耐药率高；革兰阳性菌对万古霉素敏感，而对甲氧西林部分敏感。36例医院血流感染好转率为86．11％，病情加重和病死率为13．89％。结论儿科血液肿瘤患儿医院血流感染病原菌以条件致病菌为多，其临床表现为起病急、进展快、病势凶险，故对其应重点监控，合理选用抗菌药物治疗，同时应加强抗感染支持治疗。

Analysis on hospital-acquired bloodstream infection in paediatric patients

Objective To investigate the clinical characteristics of hospital-acquired bloodstream infection in paediattic patients with hematopathy, so as to provide reference for the rational use of antimicrobial agents. Methods Clinical data of 36 cases of hospital-acquired bloodstream infection in paediatric patients with leukemia and malignant tumor from January 2003 to December 2006 were analyzed, the types and antimicrobial susceptibility results of pathogens isolated from bloodstream were analysed. Results Among 36 children with hematopathy,28 children were diagnosed as acute leukemia, 6 were aplastic anema, 2 were malignant lymphoma. Clinical characteristics were as follows：31 （86. 11 %） children＇s body temperature were ≥39℃ and associated with chilly and shiver,13 （36. 11%） children＇s blood pressure dropped, 9 （25. 00 %） cases had skin and soft tissue inflammatory small lump, 6 （16. 67 %） had abdominal pain and diarrhea, 6（16. 67%） had red lump and pain at perianal and perineum; 1 （2. 78%） case developed urinary tract infection, 8 （22. 22%） developed pneumonia. The absolute value of neutrophilic granulocytes in most children with bloodstream infection were 〈0. 5×10^9/L; The major pathogens isolated from bloods were Pseudomonas aeruginosa, Escherichia coli, Fungi, Staphylococcus aureus and coagulase negative Staphylococcus. Gram-negative bacteria were susceptible to imipenem, but highly resistant to ampicillin and the third generation cephalosporins; Gram-positive bacteria were susceptible to vancomycin, and partly susceptible to methicillin. 86. 11 % of the 36 patients improved, 13. 89% worsened and died. Conclusion The main pathogens isolated from bloodstream in paediatric patients with leukemia and malignant tumor are conditional pathogens, clinical manifestations are emergent and serious, and patients should be given strengthened surveillance, antimicrobial agents should be rationally selected, anti-infective support treatment should be stressed.