儿童非伤寒沙门菌菌血症的临床特征及耐药性分析

Clinical Characteristics and Drug Resistance Analysis of Non-Typhoidal Salmonella Bacteremia in Children

目的 回顾性分析2012~2021年我院血培养检出非伤寒沙门菌(NTS)儿童患者的临床资料和耐药性,为临床早期诊疗提供依据。方法 对我院2012年1月至2021年12月血培养检出NTS患儿临床资料进行回顾性分析,使用VITEK MS质谱细菌鉴定仪、血清凝集试验和VITEK2 COMPACT全自动药敏分析系统对NTS进行鉴定和药敏试验。结果 共25例儿童患者血液中分离出了NTS,主要为6岁以下儿童80%(20/25),主要检出月份为7~9月(60.0%)。患者主要临床表现为发热25例(100.0%),腹泻9例(36.0%),腹痛3例(12.0%),血便4例(16.0%),呕吐4例(16.0%)。实验室检查示白细胞升高14例(56.0%),CRP升高22例(88.0%),PCT升高(100.0%,10/10)。NTS血清型以D群和B群为主,分别为15株(60.0%)和6株(24.0%)。药敏结果显示对头孢唑林耐药率100%,氨苄西林耐药率60%,头孢曲松、头孢他啶和头孢吡肟敏感率均>95%,对亚胺培南和美罗培南均100%敏感。结论 NTS菌血症多发生于6岁以下儿童,多发生于夏季,血清型以D群和B群为主,临床表现多样,以发热为主,对三、四代头孢和碳青霉烯类敏感率高,临床医生应根据实验室药敏结果来选择适合的抗生素。

Objective To analyze the clinical data and drug resistance of children with NTS isolated from blood culture during 2012 to 2021,so as to provide basis for early diagnosis and treatment.Methods The clinical data of 25 children with non-typhoidal Salmonella bacteremia confirmed by blood culture from January 2012 to December 2021 were retrospectively analyzed.NTS was identified and tested by VITEK MS mass spectrometer,serum agglutination test and VITEK2 COMPACT automatic drug sensitivity analysis system.Results NTS was isolated from the blood of 25 children,20 cases under 6 years old(80.0%),60.0%were detected in July to September.The main clinical manifestations were fever in 25 cases(100.0%),diarrhea in 9 cases(36.0%),abdominal pain in 3 cases(12.0%),bloody stool in 4 cases(16.0%)and vomiting in 4 cases(16.0%).Leukocyte increased in 14 cases(56.0%),CRP increased in 22 cases(88.0%),and PCT increased(100.0%,10/10).The serotypes of NTS were mainly group D and group B,which were 15 strains(60.0%)and 6 strains(24.0%)respectively.The results of drug sensitivity showed that the drug resistance rate to cefazolin was 100%,ampicillin was 60%,The sensitivity rates of ceftriaxone,ceftazidime and cefepime were greater than 95%,and 100%to imipenem and meropenem.Conclusion NTS bacteremia mostly occurs in children under 6 years,mostly in summer.The serotypes are mainly group D and group B.The clinical manifestations are diverse,mainly fever,and the sensitivity rate to the third and fourth generation cephalosporins and carbapenems is high.Clinicians should choose appropriate antibiotics according to the laboratory drug sensitivity results.