Clinical Characteristics Of 28 Cases Of Associated With Bloodstream Infection-related Sepsis In Children

Objective: Analysis of the clinical characteristics of children with sepsis in order to improve clinicians’ understanding of sepsis;analysis of the distribution of pathogens and drug sensitivity of children with sepsis is conducive to the reasonable selection of antibiotics;to explore the risk factors leading to the death of children with sepsis.Methods: From January 2017 to September 2019,28 hospitalized children with sepsis treated in PICU ward of Tianjin Children’s Hospital were selected as subjects,and their clinical data were analyzed retrospectively.Results1.General data: Infants and young children are most common in 28 patients with sepsis,accounting for about 60.71%(17prime 28)of the total.There were 11 cases of children less than 1 year old,6 cases of 1-3 years old,4 cases of preschool children and 7 cases of school age children.2.Clinical data: In this study,community-acquired infection accounted for 85.71%,hospital-acquired infection accounted for 14.29%,mainly community-acquired infection.The clinical manifestation of sepsis is not specific,and fever is the most common symptom.The most common sites of infection are the respiratory system and the central nervous system.3.Etiological types and drug sensitivity: Gram-positive(G +)bacteria accounted for 60.71%,gram-negative(G-)bacteria accounted for 35.71%,fungi accounted for 3.57%.Streptococcus pneumoniae and Staphylococcus aureus accounted for the largest proportion in the G+ group,including 5 strains of Staphylococcus aureus,of which 3 strains of methicillin-resistant Staphylococcus aureus were resistant to penicillin and erythromycin and sensitive to linezolid and vancomycin.Haemophilus influenzae,Klebsiella pneumoniae and Pseudomonas aeruginosa were the main bacteria in G-group.The(MDR)detection rate of multiple drug-resistant bacteria in G-group was high.One strain of Klebsiella pneumoniae and one strain of Pseudomonas aeruginosa were carbapenem-resistant,resistant to quinolones and sensitive to amikacin.One strain of fungus was Candida tropicalis,which was resistant to itraconazole,voriconazole and fluconazole,but sensitive to flucytosine and amphotericin B.4.Supplementary Examination :There was no significant difference in white blood cell count,neutrophil ratio,C-reactive protein(CRP),procalcitonin(PCT),albumin and lactic acid on the day of hospitalization between G + group and G-group.There was no statistical significance in the above indexes on the day of hospitalization between the death group and the survival group.5.Application of antibiotics: In this study,the initial anti-infective treatment of children should be reasonably selected according to their epidemiological characteristics,infection site,underlying diseases,immune status,past use of antibiotics and so on.When the initial anti-infection fails,the choice of antibiotics still depends on the results of blood culture.6.Prognosis: in this study,there were 6 cases in the death group(21.43%)and 22 cases in the survival group(78.57%).During the follow-up of 3 months in the survival group,2 children with congenital nephrotic syndrome died of sepsis(no pathogen results were obtained),4 cases had sequelae,and the other 16 cases were followed up so far.7.Risk factors for death: age,albumin,neutrophils,platelets,site of infection,SOFA score and underlying diseases were statistically analyzed by exact probability method.In the univariate analysis of death caused by sepsis,only basic diseases(including nephrotic syndrome,congenital nephrotic syndrome,hematological malignant diseases,aplastic anemia,immunodeficiency disease,severe malnutrition)were statistically significant.Conclusion1.The clinical symptoms of children with sepsis are not specific,and the common infection sites are respiratory system and central nervous system.2.At present,the commonly used inflammatory and biochemical indexes play little role in distinguishing pathogens and judging prognosis.3.The infection of G + bacteria was dominant in this group,mainly Streptococcus pneumoniae and Staphylococcus aureus,and the multiple drug resistance rate of G-bacteria was high,even carbapenem-resistant strains.In the initial selection of antibiotic treatment,the epidemiological characteristics,the site of infection,the existence of underlying diseases,immune status,past use of antibiotics and other conditions should be fully evaluated,and the use of antibiotics should be selected reasonably.4.Children with sepsis with underlying diseases have a higher risk of death,while SOFA score has no correlation with prognosis,which may be related to the small number of cases in this study.