Analysis of clinical etiology in 270 children patients with severe pneumonia complicated with congenital heart disease / 国际检验医学杂志

ABSTRACT

Objective To analyze the clinical features of severe pneumonia complicated with congenital heart disease (CHD) . Methods The clinical data of 270 children patients with severe pneumonia complicated with CHD (CHD group) were collected to analyze the relative medical history ,etiology ,bacterial drug resistance and clinical outcomes .Moreover ,636 age-matched children pa-tients with pure severe pneumonia were selected as the control group .Results In the CHD group ,250 cases were infants and 35 ca-ses suffered from repeated pneumonia .Compared with the control group ,the CHD group was earlier in onset and more prone to re-peated pneumonia .Among 270 cases ,totally 220 cases were checked out the pathogens ,but no statistically significant difference in the detection rates of pathogens between the CHD group and the control group was found (P>0 .05);179 cases were infected by bacteria ,in which 126 cases were Gram-negative bacteria ,the positive rate of bacterial infection and the detection rate of Gram-nega-tive bacterial were relatively higher than those in the control group ,the difference was statistically significant (P0 .05);in the drug sensitive test ,the detection rate of extended spectrum beta lactamase (ESBLs)-producing positive bacteria in the CHD group was higher than that in the control group ,the difference was statistically significant (P<0 .05) .Main Gram-negative bacteria Pneumonia klebsiella pneumonia subspecies ,Escherichia coli and haemophilus inf luenzae were highly sensitive to imipenem ,mero-penem ,levofloxacin and ciprofloxacin ;main Gram-positive bacteria Staphylococcus aureus and streptococcus pneumoniae were highly sensitive to vancomycin and gentamicin .Especially ,pneumonia klebsiella pneumonia subspecies ,Escherichia coli and haemophilus influenzaewere100% resistanttopenicillin.TheaveragelengthofhospitalstayintheCHDgroupwas (20.9±12.5)d,207cases developed the respiratory failure ,88 cases appeared the heart failure and 205 cases were effective in treatment ;compared with the control group ,the CHD group had a longer length of hospital stay ,higher occurrence rate of heart and respiratory failure and lower treatment effective rate (P<0 .05) .Conclusion Because of the earlier onset ,more prone to repeated pneumonia ,more sensitive to bacterial infection ,esp .Gram-negative bacteria ,more ESBLs production ,longer hospital stay and more prone to complications ,com-pared with the control group ,children with severe pneumonia complicated with CHD require active treatment .