儿童化脓性链球菌致中毒性休克综合征15例

摘要

目的 了解儿童化脓性链球菌致中毒性休克综合征的临床特点.方法 回顾性病例总结.分析7家医院2010-2017年经细菌培养证实为侵袭性化脓性链球菌感染且符合链球菌中毒性休克综合征(STSS)诊断患儿的临床和实验室资料.结果 共确诊STSS 15例,其中男9例,年龄6月龄～15岁.所有患儿血培养均示化脓性链球菌生长,仅3例血培养前短暂使用过β内酰胺类抗生素.患儿发病(5.1±4.6)d就诊,均有高热,13例有多脏器功能障碍,10例弥散性血管内凝血(DIC).12例有明确感染灶,包括肺炎和(或)皮肤软组织感染.基础疾病包括1例皮肤巨大血管瘤,1例水痘.14例患儿的菌株药敏试验示均对青霉素、头孢曲松、万古霉素敏感,对克林霉素和红霉素耐药者分别有12株和13株.12例患儿的治疗药物含万古霉素,并先后或同时应用了2种及以上抗生素.8例患儿死亡,其中5例死于入院后24 h内,1例自动出院后失访.结论 儿童化脓性链球菌引起的STSS进展迅速,病死率高,应引起临床医生高度重视.%Objective To improve the understanding of clinical characteristics of streptococcal toxic shock syndrome (STSS) caused by Streptococcus pyogenes (S.pyogenes) in children.Methods A retrospective study was conducted to analyze the clinical data of STSS caused by S.pyogenes (culture-confirmed) in 7 tertiary hospitals during 2010-2017 in China.Clinical and laboratory data were collected by reviewing the medical records.Results Fifteen cases of STSS,including 9 males,were confirmed and the ages of the patients ranged from 6 months to 15 years,with median age of 3 years.All cases had the positive blood culture for S.pyogenes and only 3 cases had short course of β-lactam treatment before blood culture.Medical evaluation was initiated within (5.1 ±4.6)days after symptom onset.All patients had fever,and 13 patients had multiple organ dysfunction and 10 patients had disseminated intravascular coagulationl (DIC).Twelve cases had severe pneumonia with or without skin and (or) soft tissue infections.Underlying conditions included giant hemangioma of the skin in 2 patients and varicella in 1 patient.All isolated strains in 14 cases were sensitive to penicillin G,ceftriaxone/cefotaxime,vancomycin,but 12 and 13 isolates were resistant to clindamycin and erythromycin,respectively.Eight patients died,and 5 of them died within 24 hours after admission.One patient was lost to follow-up after intended discharge against medical advice.Conclusion STSS caused by S.pyogenes in children is a severe syndrome with rapid clinical progression and high mortality rate,and thus the pediatricians should be aware of STSS and immediately initiate aggressive treatment for the suspected cases.