儿童化脓性骨与关节感染的细菌耐药分析

Bacterial drug resistance analysis of suppurative bone and joint infection in children

目的调查分析儿童化脓性骨与关节感染的致病菌类型及其耐药情况,为临床合理使用抗菌药物提供参考。方法回顾性分析2015-2020年该院收治的骨髓炎和化脓性关节炎患儿的细菌培养结果,测定细菌对多种抗菌药物的最低抑菌浓度,统计主要致病菌对临床常用抗菌药物的耐药率,比较骨髓炎和化脓性关节炎、学龄前儿童和学龄儿童组间耐甲氧西林金黄色葡萄球菌(MRSA)的检出率及耐药率。结果共分离170株致病菌,其中金黄色葡萄球菌占比61.2%(104/170);金黄色葡萄球菌对青霉素、红霉素耐药率较高,分别为98.1%(102/104)和73.1%(76/104);MRSA总检出率为31.7%(33/104),骨髓炎和化脓性关节炎、学龄前儿童和学龄儿童组MRSA检出率,差异无统计学意义(P>0.05);MRSA对红霉素、克林霉素、环丙沙星表现出更强的耐药性,未发现对万古霉素、利奈唑胺耐药的葡萄球菌。结论金黄色葡萄球菌是儿童骨与关节化脓性感染的主要致病菌,MRSA对红霉素和克林霉素的耐药率很高,对万古霉素、利奈唑胺全部敏感,故万古霉素、利奈唑胺可作为抗感染治疗的选择。

Objective To investigate and analyze pathogenic bacteria types and drug resistance of suppurative bone and joint infections in children,and to provide reference for rational use of antibiotics in clinic.Methods Retrospectively analyzed the bacterial culture results of children with osteomyelitis and suppurative arthritis treated in this hospital from 2015 to 2020,determined the minimum inhibitory concentration of bacteria to a variety of antibiotics,and counted the drug resistance rate of main pathogenic bacteria to commonly used antibiotics clinically.The detection rate and drug resistance rate of methicillin-resistant Staphylococcus aureus(MRSA)were compared between the groups of osteomyelitis and suppurative arthritis and the groups of preschool and school-age children.Results A total of 170 strains of bacteria were isolated from these patients,Staphylococcus aureus accounted for 61.2%(104/170)of the 170 isolates.The drug resistance rates of Staphylococcus aureus to penicillin and erythromycin were 98.1%(102/104)and 73.1%(76/104)respectively.The total detection rate of MRSA was 31.7%(33/104),and there was no significant difference in the detection rate between children with osteomyelitis and suppurative arthritis,preschoolers and school-age children(P>0.05).MRSA showed stronger resistance to erythromycin,clindamycin and ciprofloxacin,and no staphylococci resistant to vancomycin and linezolid were found.Conclusion Staphylococcus aureus is the main pathogenic bacteria in children with bone and joint purulent infections.MRSA has a high drug resistance rate to erythromycin and clindamycin,and is sensitive to vancomycin and linazolid,so vancomycin and linazolid can be used as the choice of anti-infection treatment.