Clinical Characteristics Analysis In Children With Pseudomonas Aeruginosa Pneumonia

ObjectiveTo discussion the clincal characteristics in children with pseudomonas aeruginosapneumonia,to improve the level of understanding,diagnosis and treatment ofpneumonia in children infected by pseudomonas aeruginosa.Materials and Methods48cases of complete medical records comes from children with pseudomonasaeruginosa pneumonia which was confirmed by clinical and microbiological in duringof2008.1-2012.12were collected and organized，according to the source of infectionpoints community acquired pneumonia and hospital acquired pneumonia. The age ofonset, risk factors, clinical manifestations, laboratory and imaging examination results,PA drug susceptibility situation, treatment and outcome were analyzed retrospectively.Using SPSS17.0statistical package to analyze, using the chi-square test to test thestatistical data，Inspection level for alpha=0.05.Results48cases of children with PA pneumonia,10cases from the community infection, 38cases from nosocomial infection.37Male cases,11female，the ratio of male tofemale was3.4:1, less than the age of one in41patients (85.4%). Most of childrenexist underlying diseases, for patients infected pneumonia in community，it wasmalnutrition,preterm and low birth weight and the nervous system diseases. forpatients infected pneumonia in hospital，there were42.1%of them exist congenitalheart disease,36.8%malnutrition,21.1%preterm and low birth weight,13.2%thenervous system diseases. The risk factors for children with hospital acquiredpneumonia caused by Pseudomonas aeruginos usually involved endotrachealintubation(78.9%), indwelling gastric tube(73.7%), hospitalized in ICU (55.3%),application of broad-spectrum antibiotics more than seven days（44.7%）and surgery（39.5%）.Clinical manifestations:9of patients infected pneumonia in community have afever, many characterized by high fever,9cases involved cough，4cases dyspnea,moist rales could be heard in8patients,4cases complicated with heart failure,1casesrespiratory failure,3cases sepsis and pyothorax. Children acquired infection inhospital occurred fever in23cases（60.5%）, half of them for the high fever, cough in20cases（52.6%），wheezing in10cases （26.3%），dyspnea in20cases（52.6%），and apnea in8cases.25patients could be heard moist rales（65.8%). There were7patients complicated with heart failure(18.4%),18patients with respiratoryfailure(47.4%),7patients with abdominal distension and vomiting(18.4%),4patientswith sepsis(10.5%),5patients with multiple organ failure(13.2%).Laboratory examination: Levels of leukocyte count decreased in3cases，increased in31cases, CRP of20patients elevated in38children which had beentested in CRP. Imaging examination:25cases chested X-ray examination illustratesthe double lung lesions, characterized by patchy shadow,6cases combinedpulmonary consolidation, and2cases atelectasis,1case pyothorax. There were18cases have chested CT Scan-Chest,16cases characterized by bilateral lesions,13cases combined pulmonary consolidation,9cases atelectasis,4case pleural effusion.Susceptibility analysis: Sensitivity of PA strains to antibiotics from community was higher than that from hospital, the difference was significant except Amikacin,Ciprofloxacin,Levofloxacin and Aztreonam.the sensitivity to antibiotics in the order:Levofloxacin> Ciprofloxacin>Amikacin> Piperacillin-tazobactam> Cefoperazone-sulbactam>Tobramycin>Gentamycin>Meropenem>Cefepime>Ceftazidime>Ticarcillin-clavulanicacid> Piperacillin> Imipenem> Aztreonam> Cefoperazone.Antibiotic treatment:9cases of PA-CAP and19cases of PA-HAP adoptedsingle antibiotic sequential therapy, the commonly used antibiotic were Cefoperazone-sulbactam、Piperacillin-tazobactam and Meropenem. the remainder adopted drugcombination.the commonly used antibiotic combination were Cefoperazone-sulbactam/Piperacillin-tazobactam+levofloxacin/Meropenem/Imipenem,at the sametime complementary with atomized sputum suction、 application of sputumthinner,patients combined with respiratory failure were applied with ventilator,14cases were treated with intravenous gamma globulin,12cases with plasma assupportive care.3cases combined with pyothorax accepted surgery.Prognosis:7cases infected in community were cured, and3cases improved.24cases acquired from hospital were cured,3cases improved,2cases give up treatmentfor social reasons,9cases died.Conclusions1. PA pneumonia in children occurs mainly in infants.2.The sensitivity of PA strains to antibiotics from community was higher thanthat from hospital, the difference was significant.