儿童急性血源性骨髓炎致病菌分布及耐药性分析

Pathogenic bacteria and drug resistance in children with acute hematogenous osteomyelitis

目的总结儿童急性血源性骨髓炎的致病菌种类及其耐药情况,为临床抗生素的经验性用药提供参考。方法回顾性分析昆明市儿童医院2016年1月至2019年12月收治的83例急性血源性骨髓炎患儿的临床资料,男50例,女32例;年龄2个月~14岁,平均(7.4±4.2)岁。对其血培养、脓液培养、术中组织标本培养结果及药物敏感试验结果进行总结。结果 82例病例中,共培养出细菌6种,均为单菌种感染,分别为金黄色葡萄球菌72例(87.8%)、肺炎链球菌4例(4.9%)、化脓性链球菌1例(1.2%)、大肠埃希菌2例(2.4%)、铜绿假单胞菌2例(2.4%)、流感嗜血杆菌1例(1.2%)。金黄色葡萄球菌对青霉素的耐药性高达100%,对克林霉素、红霉素耐药率超过70.0%,对头孢西丁及苯唑西林的耐药率为30.6%,对利福平耐药率为4.2%,未发现对万古霉素、利奈唑胺、呋喃妥因及左氧氟沙星耐药的菌株;金黄色葡萄球菌感染病例中,耐甲氧西林金黄色葡萄球菌(MRSA)有22例,其占比有逐年增高趋势,但差异无统计学意义。结论金黄色葡萄球菌仍是目前本地区儿童急性血源性骨髓炎的最常见致病菌,MRSA感染所占比例有逐年增高的趋势,暂未发现对万古霉素耐药的菌株。

Objective To summarize the pathogenic bacteria and drug resistance in the children with acute hematogenous osteomyelitis so as to provide a reference for the empirical use of antibiotics.Methods A retrospective study was performed on the clinical data of 82 children with acute hematogenous osteomyelitis in Kunming Children′s Hospital from January 2016 to December 2019,including 50 boys and 32 girls with a mean age(7.4±4.2) years old(from 2 months to 14 years old).The results of blood culture, pus culture, intraoperative tissue culture and drug sensitivity test were analyzed and summarized.Results Among 6 species of bacteria cultured in 82 cases, all of which were infected by a single species.There were 72 cases of Staphylococcus aureus(87.8%),4 cases of Streptococcus pneumoniae(4.9%),1 case of Streptococcus pyogenes(1.2%),2 cases of Escherichia coli(2.4%),2 cases of Pseudomonas aeruginosa(2.4%) and 1 case of Haemophilus influenzae(1.2%).The resistance rate of Staphylococcus aureus to penicillin was 100%,to clindamycin and erythromycin was more than 70%,to cefoxitin and oxacillin was 30.6%,and to rifampicin was 4.2%.No strains resistant to vancomycin, linezolid, furantoin and levofloxacin were found.Among the cases of Staphylococcus aureus infection, there were 22 cases of methicillin-resistant Staphylococcus aureus(MRSA),and the proportion of MRSA increased year by year, but without statistical difference.Conclusions Staphylococcus aureus is still the main pathogenic bacteria of children with acute hematogenous osteomyelitis in this area.The proportion of MRSA infection has increased year by year, and no vancomycin-resistant strains have been found.