儿童重症监护病房铜绿假单胞菌感染临床特征与耐药分析

Clinical characteristics and antibiotics resistance of pseudomonas aeruginosa infection in pediatric intensive care unit

目的探讨儿童重症监护病房（PICU）患儿中铜绿假单胞菌（pseudomon asaeruginosa，PA）感染的临床特点及耐药情况。方法分析我院PICU 2007年1月至2009年12月收治危重患儿中PA感染的临床情况。结果（1）临床特征：问期伞院监测共获PA232株，在58例PICU患儿中，共获得PA菌株112株（48．3％）。社区获得性感染12例，医院获得性感染46例。死亡12例，病死率为20．7％，社区获得性感染和医院获得性感染病死率分别为41．6％（5例）和15．2％（7例），两组差异有统计学意义（P〈0．05）。社区获得性感染患儿主要表现为急性起病，肠道感染（5例）和败血症（5例）为主要疾病，迅速发展为休克及多器官功能障碍综合征；血白细胞不增高（7／12例）或降低（5／12例），血液c．反应蛋白和内毒素升高。医院获得性感染患儿以呼吸道感染为主要表现（38例），造成原发疾病加重，存活者住院时间延长。（2）耐药性分析：l12株PA中，头孢他丁耐药占69．8％；亚胺培南耐药率达72．8％。结论社区获得性PA感染与医院获得性PA感染临床特征有明显差别，前者多为原发性感染，病死率高。PA为医院获得性感染重要病原之一。长时问使用广谱抗生素及侵入性医疗操作可致PA感染增多。

Objective To explore the clinical characteristics of critically ill children infected with pseudomonas aeruginosa（PA） and PA antibiotics resistance in pediatric intensive care unit （PICU）. Methods Case records of children with PA infection admitted to PICU in children＇s hospital affiliated to Shanghai Jiaotong University from Jan 2007 to Dec 2009 were reviewed for clinical characteristics, case fatality rate, prognosis and drug resistance. Results （ 1 ） Clinical features： 12 cases were community-acquired infection and 46 cases were hospital-acquired infections in 58 cases. On the same period,hospital-wide surveillance obtained PA 232 strains, PICU obtained PA 112, the ratio was 48.3%. Twelve cases died and total mortality was 20. 7%. The mortality was significantly difference between community-acquired infections （5 cases, 41.6% ） and hospital-acquired infections （ 7 cases, 15.2% ） （ P 〈 0. 05 ）. The main symptom of children with community-acquired infections were intestinal infection （5 cases） and sepsis （5 cases）. The children had acute onset and developed to shock and multiple organ dysfunction syndrome rapidly. Laboratory examination revealed the white blood cell normal （7/12） and decreased in 5 cases （5/12）. The value of C-reactive protein was increased significantly, and the concentration of blood endotoxin were also increased. In the hospital acquired PA infection cases, the main symptom was respiratory abnormal （38 cases）, worsen primary disease ,extended staying days in PICU. （2）Drug resistance analysis： 112 PA ,69. 8% of ceftazidime-resistant, 72. 8% of the imipenem-resistant. Conclusion There is significant difference of the clinical features between PA community-acquired infection and hospital-acquired infection. The former is mostly primary infections with high fatality rate. PA hospital-acqnired infection has become an important pathogen of nosocomial infection in PICU. And it is important to prevent PA infection caused by a long term broad-spectrum antibiotics application and invasive medical procedures.