Chidren With Blood-borne Pulmonary Bacterial Infection:Clinical Analysis Of 80 Cases

Objective: To collect the clinical data of 80 cases with blood-borne pulmonary bacterial infection,and summarize the characteristics.Methods: Clinical information of 80 cases with blood-borne pulmonary bacterial infections who were diagnosed according to the inclusion and exclusion criteria in children diagnosed with sepsis and pneumonia for 5 years from January 2014 to December 2018 in Children's Hospital of Chongqing Medical University were retrospectively analyzed.Results: Among the 80 cases with blood-borne pulmonary bacterial infection,a total of 48 males and 32 females.The male to female ratio was 1.5: 1,age between 1.1 months to 189.0 months,mean age was 63.8 ± 57.4 months.28.8% were hospital-acquired.1.basic diseases: 48.8% cases with basic diseases,mainly hematological diseases and congenital heart disease.Cases with basic diseases have a high proportion of Gram-negative bacteria(25%).2.Clinical manifestations: all cases with fever,90% cases with high fever,40 cases(50%)without any respiratory symptoms,cough and sputum are the most common respiratory symptoms.3.Routine blood test: White blood cells increased in 34 cases(42.6%),mainly Gram-positive bacteria,white blood cells decreased in 31cases(38.8%),mainly G-bacteria.4.pathogenic examination and sensitivity: Among the 80 cases,including G+ bacteria 54(67.5%),G-bacteria 26(32.5%).The most common pathogens are Staphylococcus aureus and Streptococcus(mostly Streptococcus pneumoniae).The detection rates of Methicillin-resistant Staphylococcus aureus(MRSA)and Coagulase negative staphylococci(CNS)were 28% and 83.3%.The detection rates of ESBLs-producing Escherichia coli and ESBLs-producing Klebsiella in G-bacteria were 57.1% and 50%.5.imaging features of lung: G + bacteria lung CT showed high density clumps / flocks,nodules,and cavities is formed.G-bacteria lung CT showed sheet / patch-like shadows,with pleural effusion.6.Treatment and Prognosis: 19 cases(23.8%)have been needed surgery in this study,mainly G + bacteria(22.5%).Anti-infective treatment to all cases,treatment improved 63 cases(78.7%),treatment is ineffective 15 cases,accounting for 21.3%,there was no significant difference in prognosis between G + bacteria and G-bacteria.Conclusion: 1.Children with blood-borne lung bacterial infections are dominated by G + bacteria,while the community-acquired infections were main with G + bacteria,and the hospital-acquired infections were main with G-bacteria;those with basic diseases have a high proportion of G-bacteria especially in children with blood system diseases.2.Clinical manifestations of respiratory system in children with blood-borne pulmonary bacterial infections is hidden,children with blood-borne pulmonary infections caused by G+ bacteria are more likely to appear high fever and elevated white blood cells.3.The lung imaging performance of different pathogens have different features,but lack specificity.Although it is difficult to identify which pathogen only by chest imaging,it can provide a certain hint on the source of the pathogen to guide the treatment.4.Both G + and G-bacteria have good treatment effects after effective anti-infective treatment,but the proportion of MRCNS?ESBLs produced by Enterobacteriaceae is higher than the data of the Bacterial Resistance Surveillance Network in recent years,which needs to be attend.