儿童侵袭性铜绿假单胞菌感染抗菌药物治疗现状及菌株药敏分析

Current status of antimicrobial therapy and analysis of antibiotic sensitivity in invasive Pseudomonas aeruginosa infection in children

目的分析侵袭性铜绿假单胞菌感染(IPAI)抗菌药物治疗现状及分离菌株药敏试验结果。方法回顾分析2014年1月至2019年3月住院的61例IPAI患儿的临床资料及61株侵袭性铜绿假单胞菌(IPA)菌株的药敏试验结果,比较48例经验性抗铜绿假单胞菌治疗与13例非抗铜绿假单胞菌治疗患儿以及27例经验性碳青霉烯类治疗与19例非碳青霉烯类治疗患儿的临床特征。结果61例IPAI患儿中,男37例、女24例,中位年龄2.1(0.6~9.1)岁。院内死亡12例(19.67%),脓毒症休克15例(24.59%)。经验性非抗铜绿假单胞菌治疗患儿感染后住院时长较抗铜绿假单胞菌治疗患儿延长,差异有统计学意义(P=0.042),而重症病房入住率、院内死亡、脓毒症休克发生率的差异无统计学意义(P>0.05)。经验性碳青霉烯与非碳青霉烯治疗患儿的重症病房入住率、院内死亡、脓毒症休克发生率、感染后住院时长的差异均无统计学意义(P>0.05)。61株IPA菌株对哌拉西林/他唑巴坦、头孢他啶、头孢吡肟的敏感率为85%~90%,对亚胺培南、美罗培南的敏感率为90%~95%。结论重庆地区IPA菌株对常用抗铜绿假单胞菌抗菌药物有较高敏感性,青霉素类或头孢菌素类或其β-内酰胺酶抑制剂复合制剂可作为经验性治疗IPAI患儿的首选抗菌药物。

Objective To explore the current situation of antibiotic treatment of invasive Pseudomonas aeruginosa infection(IPAI)and the drug sensitivity test results of isolated strains.Methods The clinical data and the results of the drug sensitivity test of 61 invasive Pseudomonas aeruginosa(IPA)strains in 61 children with IPAI hospitalized from January 2014 to March 2019 were retrospectively analyzed.The clinical characteristics of 48 children with empirical anti-Pseudomonal aeruginosa treatment and 13 children with non-anti-Pseudomonal aeruginosa treatment were compared.Meanwhile,the clinical characteristics of 27 children with empirical carbapenem treatment and 19 children with non-carbapenems treatment were compared.Results Among 61 children with IPAI,37 were boys and 24 were girls,with a median age of 2.1(0.6-9.1)years.Twelve children(19.67%)died in hospital,and 15 children(24.59%)suffered from septic shock.The hospitalization days after infection in the non-anti-Pseudomonal aeruginosa treatment group was significantly longer than that in the anti-Pseudomonal aeruginosa treatment group(P=0.042),while there was no significant difference in pediatric intensive care unit(PICU)admission,hospital mortality and septic shock incidence(P>0.05).The PICU admission,hospital mortality,septic shock incidence and length of hospital stay after infection was similar between empirical carbapenem treatment group and non-carbapenem treatment group(P>0.05).The sensitivity rate of 61 IPA strains to piperacillin-tazobactam,ceftazidime and cefepime was 85%-90%,and the sensitivity rate to imipenem and meropenem was 90%-95%.Conclusions IPA strains in Chongqing area were highly sensitive to commonly used antibacterial agents against Pseudomonas aeruginosa.Penicillins,cephalosporins or theβ-lactamase inhibitor combinations can be used as the first choice for the empirical treatment of IPAI in children.