儿童骨关节及软组织感染病原菌分布及其耐药性的回顾性研究

Retrospective study on distribution and drug resistance of pathogenic bacteria in bone joint and soft tissue infection of children

目的探讨儿童骨关节及软组织感染病原菌分布情况及其药物敏感试验结果,为临床上抗菌药物的选择提供参考。方法回顾性分析河北省儿童医院骨一科2017年1月至2019年12月收治的127例骨关节及软组织感染患儿的临床资料,所有患儿均在入院后应用抗菌药物前抽取双份血培养标本和脓液行细菌培养及药物敏感试验,分析细菌培养及药物敏感试验结果。结果127例患儿中74例(58.3%)血培养或脓培养阳性。共培养出革兰阳性菌39株(52.7%),依次为金黄色葡萄球菌21株(53.8%)、溶血性链球菌6株(15.4%)、表皮葡萄球菌5株(12.8%)、肺炎链球菌4株(10.3%)、人葡萄球菌3株(7.7%);革兰阴性菌31株(41.9%),依次为大肠埃希菌14株(45.2%),肺炎克雷伯菌6株(19.4%)、流感嗜血杆菌5株(16.1%)、铜绿假单胞菌4株(12.9%)、阴沟肠杆菌2株(6.5%);真菌4株(5.4%),为白色念珠菌、光滑念珠菌、近平滑假丝酵母菌、热带假丝酵母菌各1株。所有患儿依据年龄可分为婴儿期(<1岁)、幼儿期(1~<3岁)、学龄前期(3~6岁)、学龄期(>6岁)。13例婴儿期患儿主要致病菌为革兰阳性菌;幼儿期、学龄前期及学龄期最常见的致病菌是金黄色葡萄球菌,其次是大肠埃希菌。革兰阳性菌均对万古霉素、替考拉宁及利奈唑胺高度敏感,敏感率均为100.0%,金黄色葡萄球菌对青霉素的耐药率最高,达95.2%(20/21),溶血性链球菌、表皮葡萄球菌、肺炎链球菌及人葡萄球菌与金黄色葡萄球菌的耐药菌谱类似;革兰阴性菌对美罗培南和亚胺培南高度敏感,敏感率均为100.0%,大肠埃希菌及肺炎克雷伯菌对三代头孢菌素具有较高的敏感性,而铜绿假单胞菌则对氨基糖苷类抗菌药物高度敏感。结论儿童骨关节及软组织感染在应用抗菌药物治疗时,应注意留取病原学标本进行药物敏感试验分析,没有获得药物敏感试验结果时需经验用药,获得可靠的病原菌诊断及药物敏感试验结果后改用敏感药物治疗,对减少细菌耐药性的产生非常重要。

Objective To investigate the distribution and drug sensitivity test of pathogenic bacteria in children with infection of bone,joint and soft tissue,and to provide reference for the selection of antibiotics in clinic.Methods From January 2017 to December 2019,clinical data of 127 children of bone joint and soft tissue infection in Department of OrthopedicsⅠ,Hebei Children’s Hospital were retrospectively analyzed.After hospitalized,all the children were taken two blood cultures and pus samples to carry out bacterial culture and drug sensitivity test before using antibiotics,and those results were analyzed.Results Among 127 cases,74 cases(58.3%)were positive by blood culture or pus culture.A total of 39 strains(52.7%)of Gram-positive bacteria were cultured,including 21 strains(53.8%)of Staphylococcus aureus,6 strains(15.4%)of hemolytic streptococcus,5 strains(12.8%)of Staphylococcus epidermidis,4 strains(10.3%)of Streptococcus pneumoniae and 3 strains(7.7%)of Staphylococcus hominis;31 strains of Gram-negative bacteria were isolated,including 14 strains(45.2%)of Escherichia coli,6 strains(19.4%)of Klebsiella pneumoniae,5 strains(16.1%)of Haemophilus influenzae,4 strains(12.9%)of Pseudomonas aeruginosa and 2 strains(6.5%)of Enterobacter cloacae;4 strains of fungi(5.4%)were isolated,there were 1 bacterial strain of Candida albicans,1 bacterial strain of Candida glabrata,1 bacterial strain of Candida parapsilosis and 1 bacterial strain of Candida tropicalis.According to age,all children could be divided into infancy(<1 year old),early childhood(1-3 years old),preschool(3-6 years old)and school age(>6 years old).The main pathogenic bacteria of 13 infants were Gram-positive bacteria;the most common pathogenic bacteria in early childhood,preschool and school age were Staphylococcus aureus,followed by Escherichia coli.Gram-positive bacteria was highly sensitive to vancomycin,teicoplanin and linezolid,and the sensitive rates were 100%.Staphylococcus aureus had the highest drug resistance rate to penicillin[95.2%(20/21)].Hemolytic streptococcus,Staphylococcus epidermidis,Streptococcus pneumoniae and Staphylococcus hominis had similar drug resistance spectrum to Staphylococcus aureus.Gram-negative bacteria was highly sensitive to meropenem and imipenem,and the sensitive rates were 100.0%.Escherichia coli and Klebsiella pneumoniae were highly sensitive to the third-generation cephalosporins,while Pseudomonas aeruginosa was highly sensitive to aminoglycoside antibiotics.Conclusions In the treatment of bone joint and soft tissue infection in children,pathogenic samples should be taken for drug sensitivity test.It is very important to reduce the occurrence of bacterial resistance to take empiric medication before obtaining the results of drug sensitivity test,and use sensitive drugs after obtaining reliable pathogen diagnosis and drug sensitivity test results.