ABSTRACT
Objective:To explore the clinical characteristics and risk factors of influenza virus complicated with gram-positive bacterial infection in children.Methods:The clinical data of children with influenza virus complicated with gram-positive bacterial infection hospitalized at Shenzhen Children′s Hospital affiliated to China Medical University from January 2013 to December 2019 (observation group) were retrospectively studied.During the same period, 110 hospitalized children with influenza virus infection without co-infection were selected as the control group.The clinical data of the children in two groups were analyzed.Logistic regression analysis was used to analyze the risk factors of influenza virus complicated with gram-positive bacterial infection.Results:There were 108 children in the observation group, including 68 boys and 40 girls, with the age of(2.6±1.8)years, and 100(92.6%) children under 5 years old.Incidence month distribution: 61 cases from January to March, 15 cases from April to June, 13 cases from July to September, and 19 cases from October to December.In the observation group, 73 cases were infected with influenza A virus, 35 cases were infected with influenza B virus, 94(87.0%)cases were complicated with Streptococcus pneumoniae infection, 11 cases with Group A Streptococcus infection and 8 cases with Staphylococcus aureus infection.And 15 (13.9%) cases had underlying diseases.None of the patients in the observation group received pneumococcal conjugate vaccine, and two cases received influenza vaccine within one year.There were 110 children in the control group, including 57 boys and 53 girls, with the age of (5.0±2.4)years old.There were 80 cases of influenza A virus infection and 30 cases of influenza B virus infection.Four cases had underlying diseases, six cases received 13-valent pneumococcal conjugate vaccine and 12 cases received influenza vaccine within one year.Compared with the control group, the children in the observation group were younger[(2.6±1.8)years vs.(5.0±2.4) years, χ2=-7.935, P<0.001], had more underlying diseases[13.9%(15/108)vs.3.6%(4/110), χ2=7.200, P=0.007], less proportion of influenza vaccine[1.9%(2/108)vs.10.9%(12/110), χ2=7.439, P=0.006], the hospitalization time was longer[6(5, 7)d vs.4(3, 5)d, Z=-7.278, P<0.001], and mone cases of first use of neuraminidase inhibitors(NAI) for more than 48 hours[75.9%(82/108)vs.14.5%(16/110), χ2=82.971, P<0.001]. In the observation group, there were 97 culture-positive specimens of Streptococcus pneumoniae, including 89 of sputum/bronchoalveolar lavage fluid, five of blood culture and three of cerebrospinal fluid.All Streptococcus pneumoniae were resistant to erythromycin and clindamycin; the resistance rates of non-meningitis Streptococcus pneumoniae to ceftriaxone, cefotaxime and penicillin were 7.7%, 5.5% and 1.1%, respectively, and all the strains were sensitive to vancomycin, linezolid and levofloxacin.All patients in the observation group were treated with NAI and antibiotics, 37 cases were treated with bronchoalveolar lavage, 27 cases were admitted to pediatric intensive care unit, 10 cases were treated by non-invasive continuous positive airway pressure ventilation, and 17 cases received mechanical ventilation; 6 cases died.Logistic regression analysis showed that underlying diseases, unvaccinated with influenza and (or) pneumococcal vaccine, and the first use of NAI>48 hours were risk factors for influenza virus complicated with gram-positive bacterial infection. Conclusion:Influenza virus complicated with gram-positive bacterial infection can aggravate the illness and even death of children.Early identification of gram-positive bacterial infection, timely treatment of NAI and antibiotics, and active control of complications could be helpful to improve the cure rate.Strengthening influenza and pneumococcal vaccine during flu season can help reduce infection.
ABSTRACT
Objective:To analyze the clinical characteristics of Group A Streptococcal(GAS) toxic shock syndrome (STSS) in children. Methods:The clinical data of 10 STSS children hospitalized in Shenzhen Children′s Hospital from January 2015 to March 2022 were downloaded from the electronic medical record system.The clinical manifestations were analyzed and treatment experience was summarized respectively.Results:There were 5 males and 5 females, with an average age of (5.29±2.87) years.All the patients were healthy in the past.The diagnoses were confirmed by blood culture in 2 cases, pus culture in 5 cases, and blood metagenomics next generation sequencing in 3 cases.The rapid detection of GAS antigen was positive in 7 cases.All cases had fever, and 9 cases of them developed fever after viral infection, including pneumonia in 7 cases, skin and soft tissue infections in 6 cases, necrotizing fasciitis in 3 cases, and purulent meningitis in 1 case.All cases also presented with shock.Six cases had liver function injury, and 4 cases suffered from acute kindey injury.Four cases had infection-related encephalopathy, and 7 cases were afflicted with disseminated intravascular coagulation.Two cases had respiratory failure, and 2 cases had rhabdomyolysis.There were 3 cases with a decreased white blood cell (WBC) count and 7 cases with an increased WBC count on admission.Seven cases were found to have thrombocytopenia, but their platelet levels were all elevated after recovery.C-reactive protein and procalcitonin and the proportion of neutrophils were markedly increased in all cases.All cases suffered from hypoalbuminemia, hyponatremia and hypocalcemia.All the 10 positive strains were sensitive to Penicillin, Ceftriaxone/Cefotaxime and Vancomycin.Eight cases were treated with combined antibiotics after admission.Eight patients received intravenous immunoglobulin.All cases were cured and discharged.Conclusions:The STSS progresses rapidly in children, so pediatricians should pay great attention to the disease.Early identification, diagnosis of infection sources, infusion of antibiotics and surgical treatment are the keys to disease management.