72例儿童骨与关节化脓性感染的临床分析

Bone and Joint Purulent Infection in Children: Aclinical 72 Cases Analysis

目的 评估儿童骨与关节化脓性感染的主要病原菌、耐药性演变情况 ,为临床抗生素治疗提供依据。方法回顾性分析 1995年 4月～ 2 0 0 3年 10月 ,上海市儿童医院骨科收治的 72例骨与关节化脓性感染病例的血、脓液、胸水培养和药敏及临床治疗结果。结果 金黄色葡萄球菌、大肠埃希菌、表皮葡萄球菌和铜绿假单胞菌检出率最高 ,金黄色葡萄球菌对多种抗生素呈耐药趋势。结论 耐药的金黄色葡萄球菌是儿童骨与关节化脓性感染的主要致病菌 ;近年发现大肠埃希菌和铜绿假单胞菌也占不少比例 ;儿童骨与关节化脓性感染的病程中常伴有菌血症或败血症 ;抗生素使用前应常规进行血培养 ,选用敏感的抗生素并根据药敏试验结果调整用药 ;对于金黄色葡萄球菌感染的病例 ,联合应用抗生素 ,可以提高疗效 ,避免诱导细菌产生耐药性 ,降低药物不良反应 ;疾病早期规范的抗生素治疗和及时对病灶进行手术引流 ,对减少抗生素耐药性有很大帮助并能加快疾病的愈合 。

OBJECTIVE To evaluate the pathogen of pediatric bone and joint purulent infection and the bacterial resistance to antibiotics, and to provide reference of clinical antibiotic therapy. METHODS A total of 72 cases which had bone and joint purulent infection, from Apr 1995 to Oct 2003 in Department of Orthopedics of Shanghai Children′s Hospital, were retrospectively analyzed with the results of their bacterial cultures and antibiotics sensitivity tests of blood, purulence or hydrothorax. RESULTS Inspection rate of Staphylococcus aureus, (Escherichia coli,) S. epidermidis and Pseudomonas aeruginosa were higher than others. S. aureus was less (sensitive) to most of antibiotics. CONCLUSIONS Pediatric bone and joint purulent infection is mainly caused by (S. aureus) which resist to many antibiotics, E. coli and P. aeruginosa are also often found these years. Pediatric bone and joint purulent infection is usually complicated with bacteremia or septemia. Routine blood culture (before) using of anibiotics should be taken. The sensitive antibiotics are selected and adjusted according to the (results) of blood culture and sensitivity test. Multiple antibiotics therapy could enhance effectiveness and avoid (inducing) resistance to antibiotics and reduce side effect. Normative administration of antibiotics in the early stage of the (disease) and local drainage of focus are very helpful to reduce resistance to antibiotics as well as cure the disease sooner, thus, chronic courses could hardly occurred.