A Research On The Clinical Characteristic Of Children With Pseudomonas Aeruginosa Sepsis And The Analysis Of Their Drug Resistance

ObjectiveThis thesis is mainly about the investigation of the clinical characterist ics of children with Pseudomonas aeruginosa sepsis and the analysis of their drug resistance to improve the clinical diagnosis and treatment.MethodsTo collect 46 cases of pseudomonas aeruginosa sepsis in Children's Hospital of Chongqing Medical University from January 2010 to December2016,then analyze all the clinical data retrospectively.Results1.46 children with Pseudomonas aeruginosa(PA)sepsis,there were29 males(63%,29/46)and 17 females(37%,17/46).Their ages were from6 hours to 14 years and 5 months,and under 1 year was 73.9%(34/46).PA resulting from nosocomial infection accounted for 58.7%(27/46),21.7%(10/46)had basic diseases,35 cases were from ICU treatment history and the use of ventilator assisted breathing,11 cases were from surgical history,3 cases were from glucocorticoid using,and 1 case was from burn.2.The clinical features of children with PA sepsis were various,89.1%(41/46)of them had fever,and those whose body temperatures were more than 39.0 ? accounted for 65.9%(27/41).The most common sites of infection were respiratory tract 56.5%(26/46),followed by gastrointestinal tract 32.6%(15/46)and skin 6.5%(3/46)and so on.Among all the causes of organ dysfunction,respiratory dysfunction accounted for 76.1%(35/46),blood coagulation dysfunction accounted for 54.3%(25/46),hepatic dysfunction accounted for 56.5%(26/46),nervous system dysfunction accounted for 54.3%(25/46),septic shock accounted for 30.4%(14/46),and renal dysfunction accounted for 19.6%(9/46).6.5%(3/46)of the children had ecthyma gangrenosum.3.Auxiliary examination: Increasing of white blood cell was 54.3%(25/46),decreasing of them was 30.4%(14/46),increasing of neutrophil percentage was 58.7%(27/46).hrombocytopenia was 69.6%(32/46),anemia was 95.7%(44/46).whole blood cell reduction was 28.3%(13/46).increasing of C reactive protein was 84.8%(39/46),of which more than100mg/L 32.6%(15/46);increasing of calcitonin was 63%(29/40),of which more than 10ng/ml 50%.Hypoproteinemia was 93.5%(43/46);abnormal coagulation function was 67.4%(29/43),activated partial thromboplastin time(APTT)>100 seconds was 34.9%(15/43).4.45.5%(30/66)PA can be found in sputum,22.7%(15/66)in blood,12.1%(8/66)in pus,9.1%(6/66)in stool,and 10.6%(7/66)in others.The drug susceptibility results showed that the resistant rate of PA to imipenem,meropenem,levofloxacin,ciprofloxacin and amikacin was close to 6%.And to cefepime,ceftazidime,piperacillin,piperacillin tazobactam and aztreonam,the rate was close to 10%.But to amoxicillin clavulanic acid,ampicillin and ampicillin sulbactam,cefotaxime,cefazolin,tetracycline,chloramphenicol and cotrimoxazole,the rate was close to 100%.5.Children with PA sepsis ending up dying accounted for 34.8%(16/46).Factors associated with poor prognosis were underlying disease,coagulation dysfunction,and the number of organ dysfunction.Logistic analysis showed that the factors associated with poor prognosis were the number of organ dysfunction.Conclusion1.Pseudomonas aeruginosa was one of the common conditions of pathogens,and mainly happened to the infants and young children,within 1year accounts for 73.9%.Those who with underlying diseases,steroid hormone therapy,mechanical ventilation,burns were easily infected PA.2.There was a lack of specificity in the clinical manifestations of children with PA sepsis,Most of them had fever,especially high fever.The most common sites of infection were the respiratory tract,followed by the digestive tract,and skin and so on.combined with respiratory dysfunction,coagulation dysfunction,nervous system dysfunction,liver and kidneydysfunction,septic shock and at least one organ dysfunction.Patients with ecthyma gangrenosum needed to be highly alert to PA infection.3.The result of the examination of PA sepsis was the increased leukocyte,decreased platelet and hemoglobin,decreased whole blood cell in severe infection;highly increased procalcitonin and C-reactive protein.Hypoproteinemia and coagulation dysfunction,especially the APTT was significantly prolonged.the positive culture were from sputum,blood,stool and pus.Therefore,the undiagnosed patients with unknown infection can be cultured these to help diagnosis.The data showed that PA commonly has a good sensitivity to the children's antimicrobial agents such as carbapenems(imipenem and meropenem),penicillins(piperacillin tazobactam),cephalosporins(ceftazidime and cefepime).These can be reference for the suspected PA infection in patients with empirical antibiotics selection.4.PA sepsis has high mortality and poor prognosis.Factors associated with poor prognosis were the number of underlying diseases,coagulation disorders and organ dysfunction.The factors associated with poor prognosis were organ dysfunction.