婴幼儿非发酵菌感染的临床特征和耐药分析

Clinical characteristics and drug resistance analysis of nonfermentative bacteria infection in infants

目的:对婴幼儿非发酵菌感染的临床特征和病情转归进行研究,分析感染婴幼儿非发酵菌的耐药情况,为医师识别非发酵菌感染的临床特征和及时治疗提供参考依据。方法:收集本院儿科各病区91例非发酵菌感染患儿资料,回顾性分析患儿基本临床资料及病情转归,检测非发酵菌菌株分布及耐药情况,并采用PCR法检测细菌耐药基因,对阳性结果进行基因测序分析。结果:近5年中本院儿科住院的患儿中非发酵菌感染者91例,其中新生儿35例(早产儿19例),29日龄~1岁29例,1~3岁27例;男性60例,女性31例;有基础性疾病患儿41例(45.05%),出现脏器功能损害16例(17.58%),自动出院3例(3.29%),死亡1例(1.09%);分离非发酵菌102株,其中铜绿假单胞菌42株,鲍曼不动杆菌33株,嗜麦芽窄食单胞菌21株,其他非发酵菌6株;新生儿病区44株(43.13%),小儿重症监护病房33株(32.35%),普通儿科病区25株(24.50%)。呼吸道分泌物和血液占全部标本的84.31%;鲍曼不动杆菌和铜绿假单胞菌多重耐药(MDR)、广泛耐药(XDR)、泛耐药(PDR)分离率分别占63.63%和19.04%;铜绿假单胞菌对亚胺培南耐药率为40.48%,耐药基因检测阳性率最高的是blaPER(28.57%);鲍曼不动杆菌对亚胺培南耐药率为36.36%,所有耐药株均携带blaOXA-51和blaOXA-23基因。结论:有基础性疾病或进行侵袭性诊治的患儿易感染非发酵菌,且多为耐药菌株,治疗困难,病程长,风险大。

Objective：To study the clinical characteristics,prognosis and drug resistance caused by the nonfermenting bacteria in the infants,and to provide reference for the doctors to recognize the infection features and its treatment.Methods：A total of 91 cases of non-fermentative bacteria infection were selected and the clinical materials were retrospectively analyzed.The clinical data and prognosis of the pediatric patients were analyzed,as well as the distribution and drug resistance of non-fermentative bacteria.The bacterial resistance genes were detected by PCR method,and the positive results were analyzed by gene sequencing.Results：In the past 5 years,the nonfermentative bacteria strains were isolated in 91 infant patients,including 35 cases of newborn（19cases were premature infants）,29 cases aged less than 1 year old,27 cases aged from 0 year to 3 years old.Among these patients,60 were male and 31 were female.There were 41 cases with underlying diseases（45.05%）,16 cases with organ dysfunction（17.58%）,3 cases discharged automatically（3.29%）,and 1 case dead（1.09%）.A total of 102 strains of non-fermentative bacteria included 42 strains of Pseudomonas aeruginosa,33 strains of Acinetobacter baumannii,21 strains of Stenotrophomonas maltophilia and 6 strains of other non-fermentative bacteria.Forty-four strains were isolated from neonatal ward,33 strains（32.35%）from neonatal ICU（43.13%）,25 strains（24.50%）were isolated from general pediatric ward.These strains were mainly from respiratory tract secretions and blood samples,nearly 84.31%.The isolation rates of MDR,XDR,PDR Acinetobacter baumannii and Pseudomonas aeruginosa were 63.63% and 19.04%,respectively.There were 40.48% of Pseudomonas aeruginosaisolates were resistant to imipenem,blaPER had the highest positive gene rate（28.57%）.There were 36.36% of Acinetobacter baumannii isolates were resistant to imipenem,all resistant strains carried blaOXA-51 and blaOXA-23 genes.Conclusion：The infants with underlying diseases or invasive diagnosis and treatment are easy to infect non fermentative bacteria.Most strains of them are drug-resistant and difficult to be treated with long duration and high risk.