【作者】 李媛媛；

【导师】 罗征秀；

【作者基本信息】 重庆医科大学 ， 临床医学（专业学位）， 2019， 硕士

【摘要】 目的:回顾性分析我院金黄色葡萄球菌脓毒症患儿经验性抗生素治疗现状,探讨治疗模式对其预后的影响。方法:将2014年1月至2017年8月收治的78例金黄色葡萄球菌脓毒症患儿,依据血培养报告金黄色葡萄球菌生长前经验性首选抗生素治疗类型分为碳青霉烯类治疗组(n=16)、β-内酰胺类治疗组(n=37)、万古霉素治疗组(n=15),万古霉素+β-内酰胺类治疗组(n=10)。收集各组患儿的一般情况、基础疾病、急性生理与慢性健康(APACHE II)评分、免疫抑制剂使用史、甲氧西林耐药性及预后资料,进行回顾性分析。采用logistic回归探讨经验性抗生素治疗方案对金黄色葡萄球菌脓毒症患儿临床疗效及预后的影响。结果:各组患儿一般情况、基础疾病、免疫抑制剂使用史、APACHE II评分、院内感染、MRSA检出率比较差异无统计学意义(P>0.05)。四组间脓毒性休克、院内病死率比较差异有统计学意义(P<0.05),其中碳青霉烯类治疗组脓毒性休克、院内病死率均最高(分别为69%、50%)。多因素logistic回归分析结果提示,经验性抗生素治疗类型是金黄色葡萄球菌脓毒症患儿发生脓毒性休克和院内死亡的独立危险因素(P<0.05);APACHE II评分≥15是金黄色葡萄球菌脓毒症患儿发生脓毒性休克的独立危险因素(P<0.05);与使用万古霉素治疗组相比,碳青霉烯类治疗组发生脓毒性休克和院内死亡的风险高(P<0.05)。结论:不恰当的经验性使用抗生素治疗可能导致儿童金黄色葡萄球菌脓毒症预后不佳。临床疑诊金黄色葡萄球菌脓毒症患儿,不建议经验性使用碳青霉烯类抗菌药物治疗。更多还原

【Abstract】 Objective : To investigate the relationship between empirical antibiotics therapy and clinical outcomes in children with staphylococcus aureus sepsis,the present situation of empirical antibiotic treatment in our hospital was analyzed retrospectively.Methods : Overall,78 Staphylococcus aureus sepsis children in Children’s Hospital of Chongqing Medical University in China from January 2014 to August 2017 were enrolled.According to the initial empirical antibiotics before Staphylococcus aureus growth reported,patients were divided into carbapenem group(n=16),β-lactam group(n=37),vancomycin group(n=15),vancomycin + β-lactam group(n=10).The demographic characteristics,underlying conditions,APACHE II score,Immunosuppressants use,methicillin-resistance and clinical outcomes were measured retrospectively.Results:Of the 78 cases of Staphylococcus aureus sepsis children,no statistical differences were found in the demographic characteristics,underlying conditions and acute physiology and chronic health evaluation(APACHE)II score(P>0.05),while the rate of sepsis shock and in-hospital mortality were different between these four groups(P<0.05).Among them,the carbapenem group is at the highest rate of sepsis shock and in-hospital mortality(69% and 50%,respectively).Multivariate regression test revealed that type of empirical antibiotics was independent risk factor of in-hospital mortality and septic shock incidence,APACHE II score≥15 was independent risk factor of septic shock incidence in staphylococcus aureus sepsis children.And compared to the vancomycin group,the carbapenem group had a higher rate of in-hospital mortality and septic shock incidence.Conclusions : Inadequate empirical antibiotics use may be an independent risk factor of adverse outcomes of Staphylococcus aureus sepsis children.Empirical carbapenems are not recommended for suspected staphylococcus aureus sepsis children.更多还原