目的 分析儿童大肠埃希菌血流感染的易患因素、临床特点、转归及细菌耐药性.方法 以2012年1月至2014年5月首都医科大学附属北京儿童医院血培养为大肠埃希菌的112例患儿为研究对象,男66例(58.9％),女46例(41.1％),年龄2d～16岁,其中新生儿43例(38.4％),＞28 d～1岁19例(17.0％),＞1 ～3岁14例(12.5％),＞3岁36例(32.1％).对患儿的科室分布、感染类型、基础疾病、临床特征、抗生素耐药、治疗转归及影响预后的因素等进行分析.结果 血液科46例(41.1％),新生儿中心42例(37.5％),内科9例(8.0％),外科8例(7.1％),重症监护室(PICU)7例(6.3％).有基础疾病的65例(58.0％).发热为最常见首发症状,共91例(81.3％).呼吸系统损害52例(46.4％),其中肺炎43例,呼吸衰竭3例,上呼吸道感染3例,肺出血2例,支气管炎1例,严重脓毒血症26例(23.2％),化脓性脑膜炎26例(23.2％),泌尿系统感染14例(12.5％).产超广谱β内酰胺酶(ESBLs) 73株(65.2％),其中阿米卡星耐药6株(8.2％),耐碳青霉烯类10株(13.7％).其他抗菌药物耐药率为64.6％～ 100％.转归:痊愈及好转92例(82.1％),未愈及死亡20例(17.9％).预后不良的相关因素为产ESBLs菌株感染(x2=6.609,P=0.010)、并发严重脓毒血症(x2=40.253,P=0.000)及机械通气(x2=34.441,P =0.000).结论 有基础疾病者、新生儿是大肠埃希菌血流感染的易患因素.产ESBLs菌株感染、严重脓毒血症及机械通气者预后差.碳青霉烯类可作为产ESBLs菌株感染的经验性用药,疗效不佳时,需警惕耐药菌.%Objective To analyze risk factors,clinical features,outcomes and antibiotic resistance of Escherichia coli(E.coli) causing bloodstream infections in children.Method All inpatients with E.coli positive blood culture in Beijing Children's Hospital from January 2012 to May 2014 were enrolled;112 cases were included,66 cases (58.9％) were male,and 46 cases(41.1％) were female.Age range was2 days to 16 years.Among them,43 cases (38.4％) were neonates,19 cases (17.0％) aged from 1 month to 1 year,14 cases (12.5％) were 1-3 years old,and 36 cases (32.1％) were over three years old.We analyzed the divisions to which the patients were admitted,source of infection,underlying diseases,clinical characteristics,antibiotic resistance,and treatment outcomes,etc.Result Forty-six cases (41.1％) were treated in division of hematology,42 (37.5％) in neonatology,9 (8.0％) in internal medicine,8 (7.1％) in surgery,and 7 (6.3％) in pediatric intensive care unit.Sixty-five cases(58.0％) had underlying diseases.Fever was the most frequently presented symptom,as it was seen in 91 cases (81.3％);52 cases(46.4％) had respiratory symptoms.Among these,43 cases had pneumonia,3 cases had respiratory failure,3 cases were diagnosed as upper respiratory tract infection,2 had pulmonary hemorrhage and 1 case had bronchitis.Twenty-six cases (23.2％) were diagnosed as severe sepsis and purulent meningitis separately,14 cases (12.5％) had urinary tract infection.There were 73 (65.2％) strains inducing extended spectrum β-lactamases (ESBLs),of which 6 (8.2％) and 10 (13.7％) strains were resistant to amikacin and carbapenems respectively.Resistance rate against other antimicrobial agents varied from 64.6％ to 100％.Outcomes:92 (82.1％) cases were cured or had improvement while 20 patients (17.9％) died or could not be cured at the end of treatment.Positive ESBLs (x2 =6.609,P =0.010),being complicated with severe sepsis (x2 =40.253,P =0.000) and requiring mechanical ventilation (x2 =34.441,P =0.000) indicate poor prognosis.Conclusion Patients with underlying diseases and newborns are susceptible to E.coli bloodstream infection.ESBLs infection,severe sepsis and mechanical ventilation indicate poor prognosis in E.coli blood stream infection.Clinicians may use carbapenems as empirical treatment for ESBLs infection.There may be carbapenem-resistant enterobacteriaceae strains infection if patients receiving treatment with carbapenems have no response.
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