重度营养不良患儿巨结肠术后并发造瘘口感染的病原菌耐药性分析

Drug resistance of pathogens casusing trachostoma infections in children with severe malnutrition after hirschsprung surgery

目的探讨重度营养不良患儿巨结肠术后并发造瘘口感染的病原学情况,并采用对症的方法进行治疗,以降低感染率。方法回顾性分析2011年2月-2013年1月23例重度营养不良患儿巨结肠术后并发造瘘口感染患者临床资料,对所有病例进行病原学检查及耐药率检测,观察治疗后的效果情况。结果经过前后4次检查共送标本90次,检出病原菌10种、31株,其中以金黄色葡萄球菌最多,占41.9%,与其他的病原菌比较差异有统计学意义(P<0.05);而金黄色葡萄球菌中除了万古霉素外,对其他抗菌药物的敏感性均较低,其中磺胺甲噁唑/甲氧苄啶、头孢曲松、庆大霉素、头孢唑林抗菌药物的耐药率为15.4%~53.8%,而头孢哌酮/舒巴坦、左氧氟沙星、加替沙星、克林霉素等抗菌药物的耐药率为61.5%~76.9%;尚未发现万古霉素的耐药和中介菌株,金黄色葡萄球菌对磺胺甲噁唑/甲氧苄啶的耐药性低。结论重度营养不良患儿巨结肠术后并发造瘘口感染与金黄色葡萄球菌关系密切,临床上要高度重视该病原菌的耐药性,同时加强术后护理,促进患儿康复,降低术后感染。

OBJECTIVE To explore the etiology of trachostoma infection in children with severe malnutrition after hirschsprung surgery and adopt the method of symptomatic treatment in order to reduce the incidence of infection. METHODS A retrospective analysis was performed on the clinical data of 23 cases of children with severe malnutri- tion concurrent postoperative trachostoma infection after the hirschsprung operation from Feb. 2011 to Jan. 2013, then the etiological examination was conducted for all the patients, the drug susceptibility testing was performed, and the therapeutic effect was observed. RESULTS Totally 90 specimens have been submitted through 4 times of inspection, totally 10 species of pathogens have been isolated, with the total number of 31 strains, the Staphylo- coccus aureus was dominant, accounting for 41.9 %, as compared with other species, the difference was statistical- ly signifidant（P^0.05）. The drug susceptibility of the S. aureus was lower than the drug resistance except for vancomycin; the drug resistance rates to sulfamethoxazole/trimethoprim, ceftriaxone, gentamyein, and cefazolin ranged between 15.4% and 53.8% ; while the drug resistance rates to cefoperazone-sulbactam, levofloxacin, gati- floxacin, and clindamycin varied from 61.5% to 76.9 %; the vancomycin-resistant or intermediated strains have not been detected; the drug resistance of the S. aureus to sulfamethoxazole/trimethoprim was low. CONCLUSION The S. aureus is the predominant species of pathogen causing trachostoma infection in the children with severe mal- nutrition after hirschsprung surgery; it is necessary for the hospital to focus on the drug resistance of such species of pathogen and strengthen the postoperative nursing so as to promote the rehabilitation and reduce the incidence of postoperative infections.