儿童金黄色葡萄球菌血流感染临床特征及耐药分析

Clinical Characteristics and Drug Resistance Characteristics of Staphylococcus Aureus Causing Bloodstream Infections in Children

【目的】研究儿童金黄色葡萄球菌的血流感染临床特点、易患因素、转归及耐药性,为合理控制及治疗儿童金黄色葡萄球菌血流感染提供依据。【方法】以2016年1月至2018年6月间血培养金黄色葡萄球菌阳性182例,对患儿的科室分布、感染类型、基础疾病、临床特征、抗生素耐药、治疗转归及影响预后的因素等进行分析。【结果】血培养金黄色葡萄球菌阳性182例中,①按科室分:来自新生儿科63例(34.62%)、骨科22例(12.09%)、PICU20例(10.99%)、血液肿瘤科15例(8.24%)、风湿免疫科15例(8.24%)、呼吸科13例(7.14%);②按感染来源:社区感染109例(59.89%)、医院获得性感染73例(40.11%);③有基础疾病者103例(56.59%);④首发症状中最常见的为发热148例(81.76%);⑤耐甲氧西林金黄色葡萄球菌(MRSA)141例(77.47%);⑥金黄色葡萄球菌对青霉素耐药率100%,对氨苄青霉素、红霉素、阿莫西林/克拉维酸、苯唑青霉素、氨苄青霉素/舒巴坦、头孢曲松、克林霉素严重耐药,未发现对万古霉素、利奈唑胺、达托霉素耐药菌株;⑦转归:治愈及好转161例(88.46%),未愈及死亡21例(11.54%);⑧预后的不良因素为严重脓毒血症(χ^2=68.633,P=0.000)及机械通气(χ^2=67.467,P=0.000)。【结论】有基础疾病者、新生儿是金黄色葡萄球菌血流感染的易患因素,而严重脓毒血症及机械通气者预后差,MRSA在金黄色葡萄球菌血流感染占很高比例,其中院内感染较社区获得感染比例更高,在重症金黄色葡萄球菌血流感染经验性治疗效果不佳时,应及时调整治疗兼顾MRSA感染。

【Objective】To study the clinical characteristics,predisposing factors,prognosis and drug resistance of Staphylococcus aureus(SA)blood influenza infection in children,so as to provide basis for reasonable control and treatment of this disease.【Methods】182 cases of Staphylococcus aureus positive in blood culture from January 2016 to June 2018 were analyzed in terms of department distribution,infection type,basic diseases,clinical characteristics,antibiotic resistance,treatment outcome and prognostic factors.【Results】Staphylococcus aureus in blood culture was positive in 182 cases,mainly from neonatal SA(63 cases,34.6%)orthopaedics(22 cases,12.1%),PICU(20 cases,11.0%), hematological oncology(15 cases,8.3%),rheumatic immunology(15 cases,8.3%),and respiratory medicine(13 cases, 7.1%);source of infection:community infection(109 cases,59.9%),hospital acquired infection(73 cases,40.1%);there were 103 cases with underlying diseases(56.6%);the most common initial symptoms were fever in 148 cases (81.8%),and methicillin-resistant staphylococcus aureus(MRSA)was found in 141 cases(77.5%);all staphylococcus aureus were resistant to penicillin,ampicillin,ampicillin/sulbactam,ceftriaxone and clindamycin,but no serious drug resistance was found.Prognosis:161 cases(88.5%)were cured and improved,21 cases(11.5%)were not cured and 21 cases(11.5%)died.The adverse prognostic factors were severe sepsis(χ^2 = 35.613,P = 0.000)and mechanical ventilation(χ^2 = 39.13,P = 0.000).【Conclusions】Patients with underlying diseases and newborns are the predisposing factors of blood stream infection of staphylococcus aureus,while those with severe sepsis and mechanical ventilation have poor prognosis.MRSA accounts for a high proportion of blood stream infection of staphylococcus aureus,and nosocomial infection is higher than community acquired infection.When empirical treatment of severe staphylococcus aureus bloodstream infection is ineffective,the treatment should be adjusted in time to take account of MRSA infection.