儿童侵袭性铜绿假单胞菌感染的临床特征和耐药分析

Clinical characteristics and antimicrobial resistance of invasive Pseudomonas aeruginosa infection in children

目的分析儿童侵袭性铜绿假单胞菌感染(IPAI)的临床和耐药特征,以提高诊治水平。方法回顾性分析2007年7月—2009年12月27例IPAI患儿的临床资料,采集体液标本,经实验室培养、分离,鉴定出27株铜绿假单胞菌(PA),检测其对抗生素的敏感性。结果 27例IPAI患儿1岁以下占81.5%,发病以夏秋季为主(88.9%),临床诊断败血症21例(77.8%),伴有基础疾病24例(88.9%)。医院相关性IPAI和社区相关性IPAI分别占40.7%和59.3%。临床治愈及好转15例(55.6%),死亡12例(44.4%)。PA对亚胺培南敏感率为92.6%,对头孢曲松、头孢噻肟的不敏感率分别高达88.9%和89.5%,对哌拉西林/他唑巴坦及头孢他啶等耐药率低,多重耐药率为7.4%。结论儿童IPAI好发于1岁以下,多数存在基础疾病;临床疾病以败血症最常见;PA菌株对头孢曲松、头孢噻肟耐药率较高,对亚胺培南、哌拉西林/他唑巴坦、头孢他啶等耐药率较低。

Objectives To analyze the clinical characteristics and antimicrobial resistance of invasive Pseudomonas aeruginosa infection（IPAI）in children,and to improve diagnosis and treatment.Methods The clinical data of 27 pediatric patients of IPAI from July 2007 to December 2009 were analyzed retrospectively.Body fluid samples were collected and cultured,isolated,identified in laboratory.Twenty-seven Pseudomonas aeruginosa（PA）strains were confirmed and the antibiotics susceptibility of these strains were assessed.Results Most of the IPAI patients（81.5%）were less than one year old and most episodes（88.9%）occurred in summer and autumn.Overall,21 cases（77.8%）were diagnosed with septicemia,24 cases（88.9%）were complicated with underlying diseases.The incidence of nosocomial infection and community-interrelated IPAI were 40.7% and 59.3%,respectively.Fifteen patients（55.5%）were cured or improved,and twelve（44.5%）died.PA sensitivity rate of imipenem-sensitive was 92.6%.PA non-sensitivity rate of ceftriaxone and cefotaxime were as high as 88.9% and 89.5% respectively.While PA resistance rate to piperacillin/tazobactam and other third generation cephalosporins such as ceftazidime were low.The multidrug resistance rate was 7.4%.Conclusions Most of pediatric IPAI occurred in infants with underlying diseases.Septicemia is the most common disease.PA resistance rates of ceftriaxone and cefotaxime were high,and PA resistance rates of imipenem,piperacillin/tazobactam,and ceftazidime were low.