Đặc điểm lâm sàng và cận lâm sàng nhiễm khuẩn huyết do Streptococcus pneumoniae ở trẻ em điều trị tại Khoa Điều trị Tích cực Nội khoa, Bệnh viện Nhi Trung ương

Abstract

Objective: To describe the clinical and paraclinical characteristics of pediatric patients with sepsis caused by S. pneumoniae treated at the Pediatric Intensive Care Unit. Subject and method: A retrospective descriptive study of a series of cases, including 46 pediatric patients from 1 month to 17 years old diagnosed with sepsis caused by S. pneumoniae treated at the Pediatric Intensive Care Unit, National Children Hospital, from January 2020 to August 2023. Result: Patients with sepsis due to S. pneumoniae were infants (median age was 16 months), 21.1% had underlying diseases, 15.2% were malnourished, and 47.8% had purulent meningitis. Severe clinical symptoms (87% septic shock, 93.5% respiratory failure requiring mechanical ventilation support, and 87% multiple organ failure). There was a high rate of mortality and neurologic sequelae (21.75% and 26.1%). The rate of S. pneumoniae isolated from the blood was 43.5%. Inflammation index increased (52.2% of children had increased white blood cells, 23.9% had decreased white blood cells, 47.4% had CRP > 10mg/L, 39.1% had anemia (Hb < 10g/L), 69.6% had albumin < 35g/L, 60.9% had lactate above 2.0mmol/L, 32.6% had pH below 7.25 and a high rate of coagulation disorders (81.8% had D-dimer above 500mg/L). The percentage of children with underlying diseases, isolated S. pneumoniae from the blood, failure of 3 or more organs, septic shock, lactate above 2.0mmol/L, pH ≤ 7.25, VIS index, PRISM III score of the death group was higher than the survival group (p<0.05). Pediatric patients with sepsis caused by S. pneumoniae with underlying diseases had a 20.39 times higher risk of death than the group without underlying conditions (CI: 1.502-276.67, p = 0.023). The underlying disease was an independent risk factor of mortality in pediatric patients with sepsis caused by S. pneumoniae. Conclusion: Clinical and paraclinical characteristics of pediatric patients with sepsis caused by S. pneumoniae were severe. Patients with septicemia due to S. pneumoniae who had an underlying disease were an independent risk factor related to the death of this disease.