Abstract:

Objective　To explore the clinical characteristics, drug resistance and related factors affecting disease progression of invasive Haemophilus influenzae infection in children. Methods　This was a retrospective survey. Five hundred children with invasive Haemophilus influenzae infection treated at Tongchuan People's Hospital from January 2021 to December 2023 were selected as the study objects, including 329 boys and 171 girls who were 1 month to 6 years old. Their clinical information, such as gender, age, examination results, and drug sensitivity results  were collected. The clinical characteristics and drug resistance were summarized. According to the condition status, they were divided into a severe group (227 cases) and a non-severe group (273 cases). The related factors affecting the disease progress were analyzed. t and χ² tests, logistic regression analysis, and receiver operating characteristics curve (ROC) were used for the statistical analysis. Results　Among the 500 children, there were 21 newborns, 242 infants, 139 young children, and 98 preschool children. The infection seasons were concentrated from April to June and from December to January. Three hundred and sixty-seven cases had fever, 412 cough, 125 sputum sounds, 147 wheezing sounds, and 289 fever and cough. Two hundred and eleven cases had infections by other pathogens, including 35 cases infected by respiratory syncytial virus, 41 by Mycoplasma pneumoniae, 71 by Moraxella catarrhalis, and 64 by Staphylococcus aureus. The drug sensitivity test results showed that the non-sensitive rates to cotrimoxazole,erythromycin, ampicillin, azithromycin, ciprofloxacin, and cefuroxime were 71.36% (309/433), 62.38% (262/420), 57.67% (282/489), 41.13% (153/372), 1.65% (7/423), and 0.21% (1/479), respectively; it was basically sensitive to third-generation cephalosporins, and most were sensitive to ampicillin/sulbactam. The results of logistic regression analysis showed that age, high incidence seasons, and co-infection might be the independent risk factors for disease progression in the children (OR=13.067, 1.263, and 6.863; all P<0.05). The ROC showed that age, high incidence seasons, and co-infection had high sensitivity to disease progression in the children, with the areas under the curves of 0.701, 0.606, and 0.685, respectively. Conclusions　Invasive Haemophilus influenzae infection often occurs in infants <3 years old. The high incidence seasons are in spring and winter. The clinical symptoms are mainly fever and cough, and they are susceptible to other pathogenic strains. For children with this disease, third generation cephalosporins should be used as the preferred treatment drug. Age, high incidence seasons, and co-infection may be independent risk factors affecting the disease progression of children with invasive Haemophilus influenzae infection.

Key words:

Children, Invasive Haemophilus influenzae infection, Clinical characteristics, Disease progression, Drug resistance

摘要：

目的　探讨儿童侵袭性流感嗜血杆菌感染的临床特点、耐药情况及影响疾病进展的相关因素。方法　采用回顾性分析，选取2021年1月至2023年12月在铜川市人民医院诊治的500例侵袭性流感嗜血杆菌感染患儿为研究对象，男329例，女171例，年龄1个月～6岁。收集病例的性别、年龄、检查结果、药敏结果等临床信息，总结疾病临床特点及耐药情况。根据病情状态分为重症组（227例）与非重症组（273例），分析研究影响疾病进展的相关因素。统计学方法采用t、χ²检验、logistic回归分析及受试者操作特征曲线（ROC）。结果　500例侵袭性流感嗜血杆菌感染患儿中，新生儿21例，婴儿242例，幼儿139例，学龄前期儿童98例，患病季节集中在4月～6月、12月～1月。症状表现：发热367例、咳嗽412例、痰鸣音125例、喘鸣音147例、发热合并咳嗽289例。合并其他病原体感染的有211例，其中呼吸道合胞病毒35例、肺炎支原体41例、卡他莫拉菌71例、金黄色葡萄球菌64例。药敏结果显示，非敏感率：复方新诺明71.36%（309/433），红霉素62.38%（262/420），氨苄西林57.67%（282/489），阿奇霉素41.13%（153/372），环丙沙星1.65%（7/423），头孢呋辛0.21%（1/479）；三代头孢基本敏感，氨苄西林/舒巴坦大部分敏感。logistic回归分析结果显示，年龄、高发季节、合并感染情况可能为影响侵袭性流感嗜血杆菌感染患儿疾病进展的独立危险因素（OR=13.067、1.263、6.863，均P<0.05）。ROC显示，年龄、高发季节、合并感染情况对侵袭性流感嗜血杆菌感染患儿疾病进展具有较强灵敏度，曲线下面积分别为0.701、0.606、0.685。结论　儿童侵袭性流感嗜血杆菌感染集中发生于<3岁的婴幼儿，春冬两季为高发季节，临床症状主要以发热与咳嗽为主，同时易感染其他致病菌株；三代头孢作为首选治疗药物；年龄、高发季节、合并感染情况为影响侵袭性流感嗜血杆菌感染患儿疾病进展的独立危险因素。

关键词:

儿童, 侵袭性流感嗜血杆菌感染, 临床特点, 疾病进展, 耐药