儿科血液病患儿医院血流感染分析

Analysis on Nosocomial Bloodstream Infection in Pediatric Patients

目的:探讨笔者所在医院儿科血液病患儿并发医院血流感染的临床特点及病原学分布情况,为临床治疗提供参考。方法:回顾性分析2013年1月-2014年12月笔者所在医院儿科血液病区患儿2531例的临床资料,其中血流感染患儿58例,对其感染率、感染部位、病原菌种类分布及药敏结果进行分析。结果:感染以急性淋巴细胞白血病(ALL)患儿为主,达77.59%(45/58),原发感染部位前5位依次为肺部、上呼吸道、口腔黏膜、肠道及肛周感染,所占比例分别为18.97%、13.79%、12.07%、10.34%及6.90%;感染菌种中革兰阳性菌31株(53.45%),其中表皮葡萄球菌为主要病原菌(18.97%),其次为溶血葡萄球菌(10.34%);革兰阴性菌25株(43.10%),其中肺炎克雷伯菌8株(13.79%)、大肠埃希菌7株(12.07%);感染患儿外周血中性粒细胞绝对值大多数<1.0×109/L,其中<0.5×109/L者52例(89.66%);革兰阳性菌对万古霉素敏感,而对氨苄西林、青霉素-G部分敏感;革兰阴性菌对亚胺培南敏感,对氨苄西林和三代头孢菌素耐药率高;大肠埃希菌均对青霉素-G耐药,治疗上首选亚胺培南;血流感染患儿中49例治愈,治愈率84.48%。结论:儿科血液病患儿医院血流感染的病原菌以条件致病菌居多,且革兰阳性菌逐渐成为院内感染的主要菌种,应制定针对性干预对策,合理选用抗菌药物治疗,预防并控制血液病房医院感染的发生。

Objective： To investigate the clinical characteristics and bacterial distribution of bloodstream infection in the pediatric patients of our ilospital, providing references for the elinieal study.Method： Total]y of 2531 cases of pediatrie admitted to our hospital from January 2013 to December 2014 were selected and retrospective analyzed, in whieb 58 eases were bloodstream infected and the incidence rate, infection site, pathogen distribution and antimierobial susceptibility results were analysed.Result： The most of infeeted pediatric patients were acute lymphoblastie leukemia（ALL） children, which were accounted for 77.59%, the top 5 sites of primary infection were pulmonary, upper respiratory, oral mucosa, intestinal and perianal infection, and the proportion of these infection were 18.97%, 13.79%, 12.07%, 10.34% and 6.90% respeetively.Gram positive baeteria was aeeounted for 53.45%（31 strains）, in which Staphylocoeeus epidermidis was the main pathogenic bacteria（18.97%）, followed by Staphylococcus haemolytieus（10.34%）; Gram negative bacteria was accounted for 43.10%（25 strains）, in whieh Klebsiella pneumoniae accounted for 13.79%（8 strains）, Eseheriehia eoli aceounted for 12.07%（7 strains）.The absolute value of the peripheral blood in most ehildren patient were 〈1.0 x 109/L, 52 eases（89.66%） of which were 〈0.5 x 109/L.Gram positive bacteria were sensitive to Vam：omycin, while partly susceptible to Ampicillin and Penicillin G; Gram negative bacteria were susceptible to Imipenem, while highly resistant to Ampieillin and the third generation Cephalosporins; Escheriehia eoli was resistant to Penicillin-G, and the drug of first choice was Imipenem.49 children with bloodstream infeetion were cured, the cure rate was 84.48%.Conclusion： The pathogenic bacteria of nosoeomial bloodstream infection in children are conditional pathogenic bacteria in most, and Gram positive bacteria gradually become the main strains of nosoeomial infection, the intervention strategy and antibiotie application should he formulated to prevent and control the hospital-acquired bloodstream infection in pediatric patients.