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中国循证儿科杂志

中国循证儿科杂志 ›› 2023, Vol. 18 ›› Issue (2): 129-132.DOI: 10.3969/j.issn.1673-5501.2023.02.010

• 论著 • 上一篇    下一篇

儿童非伤寒沙门菌败血症13例病例系列报告

郭帅1,2,3,万朝敏1,2,3   

  1. 1 四川大学华西第二医院儿科 成都，610041；2 出生缺陷与相关妇儿疾病教育部重点实验室 成都，610041；3 国家卫生健康委员会时间生物学重点实验室（四川大学）成都，610041
  • 收稿日期:2023-02-07 修回日期:2023-04-25 出版日期:2023-04-25 发布日期:2023-05-19
  • 通讯作者: 万朝敏

13 cases of non-typhoid salmonella septicemia in children: A case series report

GUO Shuai1,2,3, WAN Chaomin1,2,3   

  1. 1 Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu 610041, China; 2 Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Chengdu 610041, China; 3 Key Laboratory of Chronobiology, National Health Commission, Chengdu 610041, China
  • Received:2023-02-07 Revised:2023-04-25 Online:2023-04-25 Published:2023-05-19
  • Contact: WAN Chaomin

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摘要： 背景:非伤寒沙门菌（NTS）发生侵袭性血流感染可引起败血症，诊治不及时会引起严重并发症甚至死亡。 目的:总结分析儿童NTS败血症的临床特征及治疗经验。 设计:病例系列报告。 方法:纳入2017年11月至2022年10月在四川大学华西第二医院经血培养明确诊断为NTS败血症的患儿。通过医院电子病历系统收集患儿的一般资料、临床表现、辅助检查、治疗及转归。 主要结局指标好转出院或死亡。 结果:13例NTS败血症患儿纳入本文分析，发病中位年龄为1（0.9，6）岁，＜5岁10例，男5例，7例存在基础疾病。除1例有不洁饮食史外，余无明确感染来源。发病时间7~9月份占76.9%。均有高热，10例（76.9%）以发热为首发症状，腹泻、咳嗽各6例，其余症状还包括气促、精神萎靡、抽搐、呕吐、血便、皮疹、骨关节痛、喘息、发绀和黄疸。合并胃肠炎6例，肺炎5例，脑膜炎和骨髓炎各1例。WBC和PLT升高各3例，CRP显著升高8例，PCT显著升高、Hb降低、ALT/AST升高各6例。血培养肠炎沙门菌和鼠伤寒沙门菌各3例，德比沙门菌、都柏林沙门菌和纽兰沙门菌各1例，未分型4例；血培养转阴时间为5（4.5，13.5）d。12例菌株存在不同程度耐药，7例为多重耐药。对阿米卡星（92.3%）、妥布霉素（92.3%）、庆大霉素（92.3%）耐药率较高，其次为氨苄西林（69.2%）、磺胺甲噁唑/甲氧苄啶（30.8%），无碳青霉烯类耐药，多数对第三、四代头孢菌素和氨曲南敏感。抗生素中位疗程为17（14，21.5）d。13例均好转出院。 结论:NTS败血症多发生于5岁以下儿童，以高热为主要临床表现，伴或不伴胃肠道症状，明确诊断依据病原学检测。经验性用药推荐第三代头孢菌素，多数患儿可获得较好的临床效果，对于一线治疗效果不佳、严重感染者建议使用碳青霉烯类药物。

关键词: 非伤寒沙门菌, 败血症, 儿童, 临床特点, 抗生素耐药

Abstract: Background:Invasive bloodstream infections with nontyphoid salmonella (NTS) can result in septicemia, and untimely diagnosis and treatment can lead to severe complications and death. Objective:To summarize and analyze the clinical features and treatment experience of NTS septicemia in children. Design:Case series report. Methods:Children diagnosed with NTS septicemia by blood culture at the Sichuan University West China Second University Hospital from November 2017 to October 2022 were enrolled. Data on general information, clinical manifestations, laboratory examinations, treatments, and prognosis of the children were collected through the hospital medical record system. Main outcome measures:Discharge with improvement or death. Results:A total of 13 children with NTS septicemia were enrolled, and the age of onset was 1 year (0.9, 6 years), of which 10 were <5 years. Five were males and 7 had comorbidities. The source of infection was unknown except for one patient who had eaten infected food. The time of onset was from July to September（76.9%）. All patients had a high fever, and 10 (76.9%) had a fever as their first symptom; 6 had diarrhea and 6 had cough. The rest symptoms included shortness of breath, depression, convulsions, vomiting, bloody stools, rash, bone and joint pain, wheezing, cyanosis, and jaundice. There were 6 cases of gastroenteritis, 5 cases of pneumonia, and 1 case of meningitis and 1 case of osteomyelitis. Laboratory result showed increased WBC in 3 cases, increased PLT in 3 cases, increased CRP in 8 cases, increased PCT in 6 cases, decreased Hb in 6 cases, and increased ALT/AST in 6 cases. Blood cultures obtained 3 cases of Salmonella Enteritidis and Salmonella Typhimurium respectively, and 1 case of Salmonella Derby, Salmonella Dublin and Salmonella Newlands respectively, and 4 untyped cases. The blood culture turned negative at 5 (4.5, 13.5) days. Twelve were drugresistant and 7 were multidrugresistant. High resistance rates were observed for amikacin (92.3%), tobramycin (92.3%), and gentamicin (92.3%), followed by ampicillin (69.2%) and sulfamethoxazole/trimethoprim (30.8%). No carbapenems were resistant. Most were sensitive to third and fourthgeneration cephalosporins and aztreonam. The duration of the antibiotic therapy was 17 (14, 21.5) days. All of 13 children recovered and were discharged. Conclusions:NTS septicemia occurs mostly in children under 5 years old with a high fever as the common clinical manifestation and is likely to be accompanied by gastrointestinal symptoms. The diagnosis depends on pathogenetic testing. Thirdgeneration cephalosporins are recommended for empirical treatment, and most patients can obtain a good clinical outcome. Carbapenems are recommended for patients with ineffective firstline therapy and severe infections.

Key words: Non-typhoid salmonella, Septicemia, Children, Clinical features, Antibiotic resistance