儿童社区获得性复杂性腹腔感染的流行病学及临床治疗研究

Epidemiologic characteristics of community-acquired complicated abdominal infections in children and clinical treatment

目的调查0～15岁儿童社区获得性复杂性腹腔感染的流行病学、病原学特征及治疗方法,为儿童复杂性腹腔感染的治疗提供依据。方法回顾性分析2005-2011年146例住院患儿中患有复杂性腹腔感染年龄<15岁的临床资料,采用培养基或注射器无菌收集复杂性腹腔感染患儿手术中的腹腔标本,病原菌的鉴定采用VITEK-2Compact全自动鉴定仪进行;采用统计软件SPSS13.0进行χ2检验。结果 146例复杂性腹腔感染患儿中有128例为复杂性急性阑尾炎,占87.67%,其中142例送检标本培养阳性,阳性率为97.26%;共分离出212株病原菌,以大肠埃希菌为最常见病原菌,产ESBLs大肠埃希菌和肺炎克雷伯菌检出率较高,分别为57.73%和53.84%;两者对碳青霉烯类抗菌药物的敏感率均为100.00%,其次为哌拉西林/他唑巴坦、头孢哌酮/舒巴坦和阿米卡星,均<40.00%;屎肠球菌耐药率明显高于粪肠球菌(P<0.05);有34例患儿抗菌药物单一使用二代或三代头孢菌素,在联合用药的112例患儿中有79.46%患儿使用头孢菌素联合硝基咪唑类药物;患有阑尾周围脓肿的患儿治疗后体温降至<37.5℃所用时间明显短于弥散性腹膜炎的患儿(P<0.05)。结论儿童复杂性腹腔感染治疗需要外科手术或与引流结合抗菌药物治疗,临床应在经验用药的基础上根据药敏试验结果合理选择抗菌药物。

OBJECTIVE To investigate epidemiologic and etiological characteristics of the community-acquired complicated abdominal infections in children aged between 0 and 15 years old and explore the treatment measures so as to guide the treatment of complicated abdominal infections. METHODS The clinical data of 146 children （less than 15 years of age） with complicated abdominal infections who were hospitalized during 2005- 2011 were retrospectively analyzed, then the abdominal specimens were collected with the use of culture medium or syringe, the identification of pathogens was performed by using VITEK-2 Compact automatic identification system, and the chi-square test was conducted with the use of SPSS13. 0 software. RESULTS Of totally 146 children with complicated abdominal infections, there were 128 （87.67 %） cases of complicated acute appendicitis, among which 142 submitted specimens were cultured positive with the positive rate of 97. 26%. A total of 212 strains of pathogens have been isolated, among which Escherichia coli was the most common species; the detection rates of the ESBLs-producing E. coli and Klebsiella pneumoniae were the highest, which were 57. 73% and 53. 84%, respectively. The drug susceptibility rates of the ESBLs-producing E. coli and K. pneumoniae to carbapenems were 100.00 %, and the drug susceptibility rates to piperacillin-tazobactam, cefoperazone-sulbactam, and amikacin were less than 40.00% the drug resistance rate of Enterococcus feces was significantly higher than that of the Enterococcus faecalis （P〈0.05）. There were 34 children who have used the first generation cephalosporins or third generation cephalosporinsl among the 112 children who have taken the combination drug therapy, 79.46% have used the cephalosporins combined with nitroimidazoles （P〈0. 05）. The interval that the body temperature descended to below 37.5℃ of the children with appendiceal abscess was significantly shorter than that of those with disseminated peritonitis（P〈0.05）. CONCLUSION The surgical treatment or drainage in combination with antibiotics therapy are recommended for the treatment of the children with complicated abdominal infections, and it is necessary for the hospital to reasonably use antibiotics based on the result of drug susceptibility testing. ,