儿童血流感染唐菖蒲伯克霍尔德菌的临床特点及其药敏分析

Clinical features of children with Burkholderia gladioli bloodstream infection and drug susceptibility of Burkholderia gladioli

目的探讨儿童血流感染唐菖蒲伯克霍尔德菌(B.gladioli)的临床特点及其药敏分析。方法回顾性分析2015年1月至2016年1月华中科技大学同济医学院附属武汉儿童医院收治的63例血流感染B.gladioli和81例同期非细菌感染性疾病患儿的临床资料,比较两组患儿的C-反应蛋白(CRP)水平、降钙素原(PCT)水平和白细胞(WBC)计数。分离培养B.gladioli,使用Phoenixtm100型全自动微生物鉴定仪进行细菌初步鉴定,并用MALDI-TOP/MS质谱仪进行验证。采用纸片扩散法(Kirby-Bauer法)进行B.gladioli的体外药敏试验。结果感染B.gladioli的患儿主要集中在婴幼儿时期,年龄≤3岁者占82.54%(52/63)。所有患儿均患有严重的基础疾病,主要为支气管炎、肺炎和白血病等。与非细菌感染组比较,感染B.gladioli组患儿的PCT水平、CRP水平和WBC计数均升高,差异均有统计学意义(P均<0.05)。依据铜绿假单胞菌药敏标准,分离的B.gladioli对阿米卡星、庆大霉素、四环素、米诺环素、复方新诺明、环丙沙星、左氧氟沙星、亚胺培南、美罗培南、头孢吡肟、哌拉西林、哌拉西林/他唑巴坦和头孢哌酮/舒巴坦高度敏感,对氯霉素低度耐药,对头孢他啶、氨曲南高度耐药。结论感染B.gladioli的患者常为年龄≤3岁、免疫力低下、抵抗力差的患儿。血培养及CRP水平、PCT水平和WBC计数可作为疾病转归的判断指标。哌拉西林/他唑巴坦、头孢哌酮/舒巴坦是儿童感染B.gladioli的首选治疗药物。

Objective To explore the clinical features of children with Burkholderia gladioli（B. gladioli） bloodstream infection and the drug susceptibility of B. gladioli. Methods The clinical data of 63 children with B. gladioli bloodstream infection admitted to Wuhan Children＇s Hospital, Tongji Medical College of Huazhong University of Science and Technology from Jan. 2015 to Jan. 2016 were retrospectively analyzed, and 81 children with non-bacterial infectious diseases in the same period were enrolled as controls. The C-reactive protein（CRP） level, procalcitonin（PCT） level and white blood cell（WBC） counts of children were compared between the two groups. B. gladioli was isolated from the blood samples of children and cultured for preliminary identifying by Phoenixtm100 automatic microorganism identification instrument and confirming by MALDI-TOP MS mass spectrometer. The in vitro antimicrobial susceptibility testing of B. gladioli were performed by Kirby-Bauer method. Results The children infected with B. gladioli were mainly infants, with 52 cases（82.54%） being three years old or below. All cases had serious underlying diseases, including bronchitis, pneumonia and leukemia. Compared with the control group, the PCT level, CRP level, and WBC counts in the children of the B. gladioli group were significantly increased（all P〈0.05）. According to the drug susceptibility criteria of Pseudomonas aeruginosa, the isolated B. gladioliwas highly sensitive to amikacin, gentamycin, tetracycline, minocycline, cotrimoxazole, ciprofloxacin, levofloxacin, imipenem, meropenem, cefepime, piperacillin, piperacillin/tazobactam and cefoperazone/sulbactam, but had low resistance to chloramphenicol and high resistance to ceftazidime and aztreonam. Conclusion Children infected with B. gladioli are mainly infants aged≤3 years old, with low immunity and poor resistance. Blood culture and CRP level, PCT level and WBC counts can be used as diagnostic indicators of disease outcomes. Piperacillin/tazobactam and cefoperazone/sulbactam should be the first selected drugs for the treatment of children with B. gladioli bloodstream infection.