败血症小儿人苍白杆菌感染的临床表现及其耐药分子特征

Clinical manifestations of Ochrobactrum anthropi infection and molecular characteristics of drug resistance in children with septicemia

目的 分析败血症患儿人苍白杆菌感染的临床表现及其耐药分子特征。方法 收集2018年1月-2020年12月河南省妇幼保健院收治的败血症患儿人苍白杆菌临床分离株98株,分析患儿临床特点,药敏试验分析耐药性,三维试验法检测AmpC酶,聚合酶链反应(PCR)检测耐药基因。结果 98例人苍白杆菌败血症患儿中,男64.29%,女35.71%,1~3岁居多(占63.27%),临床表现以发热最为常见(91.84%),其次为精神欠佳(52.04%),实验室指标中,谷草转氨酶升高最为常见(68.37%),其次为白细胞增多(56.12%)。98株人苍白杆菌对美罗培南的敏感率为100.00%,对亚胺培南、丁胺卡那、环丙沙星、左氧氟沙星、阿米卡星的敏感率均>90%,对磺胺甲噁唑/甲氧苄啶和庆大霉素的敏感率均>80%。对氨曲南耐药率为100.00%,对氨苄西林、哌拉西林/他唑巴坦、头孢唑林、头孢克洛、头孢他啶的耐药率均>90%,对头孢替坦的耐药率>80%。98株人苍白杆菌中产AmpC酶菌株90株(91.84%);9种耐药基因中,AmpC检出率为91.84%,DHA-1、aac(3)-II、aac(6’)-II、TEM及SHV的检出率分别为11.22%、1.02%、2.04%、5.10%和3.06%,而aac(3)-I、aac(6’)-I和PER未检出。结论 人苍白杆菌败血症患儿多为3岁以下儿童,临床表现以发热、精神欠佳为主,实验室指标多见谷丙转氨酶升高和白细胞增多,对β-内酰胺类的多种抗菌药物耐药,主要与AmpC基因有关。

OBJECTIVE To analyze the clinical manifestations of Ochrobactrum anthropi infection in children with septicemia and its molecular characteristics of drug resistance.METHODS Totally 98 strains of clinical isolates of Ochrobactrum anthropi from children with septicemia admitted to Henan Provincial Maternal and Child Health Hospital between Jan.2018 and Dec.2020 were collected,the clinical characteristics of the children were analyzed,and the drug resistance was analyzed by drug sensitivity,AmpC enzyme was detected by three-dimensional test and the drug resistance genes were detected by polymerase chain reaction(PCR).RESULTS Among 98 children with septicemia of Ochrobactrum anthropi,64.29% were males and 35.71% were females.Most of children were 1-3 years old,accounting for 63.27%.Fever(91.84%) was the most common clinical manifestation,followed by poor spirit(52.04%).Among the laboratory indicators,elevated aspartate aminotransferase was the most common(68.37%),followed by leukocytosis(56.12%).The sensitive rates of 98 strains of Ochrobactrum anthropi were 100.00% to meropenem,and more than 90% to Imipenem,amikacin,ciprofloxacin,levofloxacin and amikacin,and more than 80% to compound sulfamethoxazole and gentamicin.The drug resistance rates were 100.00% to aztreonam,more than 90% to ampicillin,piperacillin/tazobactam,cefazolin,cefaclor and ceftazidime,and more than 80% to cefotetan.90 strains(91.84%) of 98 strains of ochrobactrum anthropi were AmpC enzyme-producing strains.Among the nine durg-resistant genes,the detection rate of AmpC was 91.84%,and the detection rates of DHA-1,aac(3)-II,aac(6’)-II,TEM and SHV were 11.22%,1.02%,2.04%,5.10% and 3.06%,respectively,while aac(3)-I,aac(6’)-I and PER were not detected.CONCLUSION Most of the children with septicemia of Ochrobactrum anthropi were under 3 years of age.The clinical manifestations are mainly fever and poor spirit,with elevated alanine aminotransferase and leukocytosis as the most common laboratory indicators,and resistance to multiple β-lactams antibacterial drugs,which was mainly associated with the AmpC gene.