血液病患儿医院感染大肠埃希菌败血症调查分析

SURVEY ON HOSPITAL INFECTION OF E.COLI-INDUCED HEMATOSEPSIS IN CHILDREN WITH HEMATOPATHY

目的 探讨血液病患儿大肠埃希菌败血症特点及其耐药性。方法 回顾性调查分析 1997年至 2 0 0 4年间住院血液病患儿感染大肠埃希菌败血症者的临床及细菌耐药性。结果 90 2例次住院血液病患儿中 ,血液感染大肠埃希菌者 19例 ,多数为恶性血液病 ,感染均发生在化疗、应用大剂量糖皮质激素和 (或 )广谱抗生素之后 ,除 1例ITP外 ,中性粒细胞均 <0 .5× 10 9/L。大肠埃希菌对亚胺培南高度敏感 ,对氨苄青霉素、头孢唑林、磺胺药耐药率达 10 0 % ,对庆大霉素、头孢噻肟、环丙沙星、阿莫西林 /棒酸、氨曲南耐药率达 80 %以上 ,产ESBLs菌达 6 9.2 3%。结论 血液病患儿感染大肠埃希菌败血症 ,是由于免疫功能严重抑制 ,粒细胞缺乏 ,菌群失调引起 ,以内源性感染为主 ,故应提高机体的免疫功能 ,对粒细胞缺乏者应进行肠道脱污染 ,治疗上可选用亚胺培南、头孢他定、头孢西丁、妥布霉素、哌拉西林 /他唑巴坦、头孢吡肟等。

Objective To explore the clinical characteri st ics and drug-resistance of E.coli-induced hematosepsis in children iwth hematopa thy.Methods Retrospective analyses of the clinical characteristic s and drug-resistance of E.coli-induced hospital infection of hematosepsis in children with hematopathy treated from 1997 to 2004 were made.Results 19 of all the 902 cases of hematopathy were infected with E.coli,and most o f which were of malignant hematopathy.Most infections(excluding a case of ITP) o ccurred after chemothepy or after application of large dosages of glucocorticoid hormone and/or brood-spectrum antibiotics.The volume of neutrophilic granulocy te was less than 0.5×10 9/L.E.Coli responded extremely sensitively to imipenem .The rate of resistance to ampicillin,cefazolin and sulfonamides was 100%.And th e rate of resistance to gentamycin,cefotaxime,ciprofloxacin,amoxillin and aztreo nam was over 80%.The rate of reproduction of bacterial ESBLs was 69.23%. Conclusion The infections of E.coli hematosepsis,most of which were endo genous,mainly resulted from the severe prohibition of immune functions,lack of n eutrophilic gradulocytes and flora imbalance.They should be treated by promoting immune functions,removing the pollution of intestinal tracts of cases lacking i n gradulocytes,and unsing such drugs as imipenem,cefazidime,cefoxitin,tobramycin ,piperacillin/tazobactam and cefecpime.