儿童社区获得性耐甲氧西林金黄色葡萄球菌感染的临床特征及耐药分析  

Analysis of clinical characteristics and antimicrobial resistance of community-acquired MRSA in children

作　　者：李海燕[1] 董琳[1] 王志远[1] 张同强[1] 

机构地区：[1]温州医学院附属育英儿童医院呼吸科,浙江温州325027

出　　处：《温州医学院学报》2012年第1期36-40,共5页Journal of Wenzhou Medical College

摘　　要：目的:总结儿童社区获得性耐甲氧西林金黄色葡萄球菌(CA-MRSA)感染的临床特征及对抗菌药物的耐药性,以提高对该病原菌感染的诊疗水平,指导抗菌药物的合理应用。方法:回顾性分析2004年1月-2010年12月CA-MRSA感染住院患儿的临床和细菌药敏资料。结果:CA-MRSA感染患儿共130例,其中男77例,女53例,男女比1.5:1,年龄2 d～14岁,1岁以下72例(占55.4%),1～5岁37例(占28.5%)。临床疾病以皮肤软组织感染(SSTIS)最多见,占78.5%,其次为败血症(占10.0%)、化脓性骨髓炎(占3.8%)、肺炎(占2.3%)及脓气胸(占1.5%)等。3例有基础疾病,分别为房间隔缺损、营养不良及急性早幼粒细胞白血病。130例患儿中治愈102例(占78.5%),好转28例(占21.5%)。药敏试验结果显示CA-MRSA均为多重耐药,对β内酰胺类抗生素及其酶抑制剂的复合制剂完全耐药,对红霉素和克林霉素耐药率分别为70.0%和46.2%;对左氧氟沙星、环丙沙星、利福平、庆大霉素、SMZco尚有较高敏感性,敏感率分别为92.3%、90.8%、91.5%、86.8%、72.3%,尚未发现对万古霉素及利奈唑胺耐药的菌株。结论:CA-MRSA感染好发于5岁以下尤其是1岁以内儿童,临床疾病以皮肤软组织感染多见,97.7%患儿既往体健。CA-MRSA对常用抗菌药物呈现多重耐药,但临床预后良好。Objective：To investigate the clinical characteristics and antimicrobial resistance of community-acquired MRSA（CA-MRSA） infection and to guide antimicrobial therapy in children.Methods： All isolates were collected from inpatients in our children＇s hospital from January 1,2004 to December 31,2010.A retrospective analysis of clinical data and antimicrobial susceptibility were recorded.Results： One hundred and thirty children aged 2 days to 14 years old were enrolled in this study,including 77 males and 53 females,and the ratio of boys and girls was 1.5：1.The proportion of patients younger than 1 year old and one year to five years old was 55.4% and 28.5%,respectively.The most common disease was skin and soft-tissue infections with the proportion of 78.5%,followed by septicemia（10.0%）,osteomyelitis（3.8%）,pneumonia（2.3%） and pyopneumothorax（1.5%）.There were only three cases（1.5%） combined with underlying disease,atrial septal defect,malnutrition and acute promyelocytic leukemia,respectively.One hundred and two（78.5%） cases were cured and 28（21.5%） cases improved.Antimicrobial sus-ceptibility test indicated that CA-MRSA isolates were multidrug resistance.The isolates were resistant to β-lactams and its enzyme inhibitors.The resistance rates to erythromycin and clindamycin were 70.0% and 46.2%,respectively.CA-MRSA isolates were susceptible to several non-β-lactams antimicrobials,with 92.3% susceptible to levofloxacin,90.8% to ciprofloxacin,91.5% to rifampicin,86.8% to gentamicin and 72.3% to SMZ/TMP.There were no isolates resistant to vancomycin and linezolid.Conclusions： Children aged less than 5 years,especially younger than 1 years old are prone to CA-MRSA infections.The main diseases caused by CA-MRSA are SSTIs and 97.7% cases have no underlying diseases.Although the strains of CA-MRSA are multidrug resistance,the outcomes are pretty good.

关 键 词：耐甲氧西林金黄色葡萄球菌 社区获得性 临床特点 抗生素耐药性 儿童 

分 类 号：R725.6[医药卫生—儿科]