Retrospective Clinical Study On The Etiology Of Septic Shock In 205 Children

Objective:A retrospective study on the etiology of septic shock diagnosed by picu in Shenzhen Children's Hospital in recent 10 years was carried out.To investigate the etiological distribution and characteristics of children with septic shock and the common bacterial drug resistance,so as to provide reference data for clinical early empirical selection of antibiotics,so as to improve prognosis and survival rate.Methods:Diagnostic criteria for septic shock in children in accordance with the 2015edition of the consensus of experts on the diagnosis and treatment of septic shock,screened205 children with septic shock,who had been admitted to PICU of the Shenzhen Children's Hospital out from August 2007 to December 2017.Collection of medical history,clinical features related to infection,leukocyte(WBC),C-reactive protein(CRP),procalcitonin(PCT)and etiological examination,etc.To know the distribution of pathogens,analyze the clinical characteristics of children with septic shock caused by pathogens with number of cases?10,the relationship between etiological results and the changes of WBC,CRP and PCT,and the resistance of the first five bacteria to commonly used antibacterials.Results:1.General information:A total of 205 children met the diagnostic criteria in the study stage,accounting for 3.0%(205?6918)of the hospitalized children in the same period of PICU,and the fatality rate was 44.9%(92?205).The age of the child was 1~15years,the median age was 10 months,the proportion of the baby was the largest,accounting for 58.5%(120/205).2.Etiological situation:There are 123 cases of 205 children with definite pathogen were detected account for 60%,the proportion of bacterial is 54.1%(111/205),the proportion of virus is 5.9%(12/205).The highest positive rate of blood culture was 65.0%(80/123)in123 children with definite pathogen.Among 111 children with definite bacteria,G-bacteria and G+bacteria accounted for 66.4%and 33.6%,respectively.The first five bacteria were Pseudomonas aeruginosa(PA)of 23 cases,Klebsiella pneumoniae(KP)of 19 cases,Escherichia coli of 18 cases.14 cases of Streptococcus pneumoniae and 7 cases of Staphylococcus aureus(including 4 cases of MRSA),accounting for 73.0%(81/123).3.Clinical characteristics of children with bacterial infection?10 cases:All PA infections were community acquired.82.6(19/23)of the patients in the past was healthy,the median age was 7 months,and 52.2%(12/23)of the patients had respiratory system onset.There are 69.6%(16/23)patient?s WBC decreased.47.4%(9/19)of KP was detected in children with blood tumors.The incidence of Escherichia coli infection was 66.7%(12/18),which was characterized by digestive system.The highest heat peak value of invasive Streptococcus pneumoniae infection was(39.9±0.6)?,all of which were invasive infections.The symptoms occur in central nervous system and respiratory system accounted for 57.1%(8/14)and 42.9%(6/14),respectively.4.Pathogen and commonly used microbial markers:The decrease rate of WBC in bacterial group was 43.2%(48/111),and that in unknown pathogen group was 24.4%(20/82).The increase rate of WBC in unknown pathogen group was 48.8%(40/82),which was higher than that in bacteriological group 29.7%(33/111).The proportion of CRP>100mg/l in bacteria group and unknown pathogen group was 66.7%(74/111),51.2%(42/82),and8.3%(1/12)in virus group,respectively.But the proportion of CRP<10mg/l and 10?CRP?100mg/l in virus group was higher than that in bacterial group and unknown pathogen group.The PCT>2ng/ml of patient accounted for 87.8%(79/90)in bacteria group and77.4%(48/82)of in the unknown pathogen.5.Drug resistance of common bacteria:The first three G~-were 100%sensitive to carbapenem.The resistance rates of ESBL+KP to common antibiotics were piperacillin tazobactam 42.8%,ceftazidime 71.4%,ceftriaxone 100%,cefepime 42.8%.ESBL+Escherichia coli is also 100%sensitive to piperacillin tazobactam and highly resistant to other commonly used ceftriaxone,ceftazidime and cefepime.PA was sensitive to cefepime and ceftazidime(90.9%)and was highly resistant to ceftriaxone.Streptococcus pneumoniae was 100%sensitive to vancomycin,linezolid and imipenem,100%resistant to erythromycin,21.4%and 28.6%to cefotaxime and ceftriaxone sodium,respectively.Conclusion:1.Bacterial infection is the main pathogen of septic shock in children in Shenzhen,and blood flow infection is more common.The first four pathogens are PA,KP,Escherichia coli and Streptococcus pneumoniae,and MRSA infection can also be seen.2.Most of the community acquired pa infections occurred in healthy infants,the age was about 7 months old,and the respiratory system was the main manifestation.Most of KP occurs in children with blood tumors.Streptococcus pneumoniae mainly invades the central nervous system and respiratory system,with high fever as the main manifestation.Escherichia coli infection is more common in the digestive system.3.WBC increased and decreased.CRP>100mg/l and PCT>2ng/ml highly suggested bacterial infection,but normal white blood cells could not rule out bacterial infection.4.The initial empirical antibiotic selection in children with septic shock needs to consider covering PA,KP,Escherichia coli,Streptococcus pneumoniae,MRSA and other possible pathogens according to the clinical characteristics of children.