儿童人苍白杆菌败血症临床特点及ampC基因检测  

Clinical characteristics of septicemia infected with Ochrobactrum anthropi in children and AmpC genetic testing

作　　者：李先斌[1] 刘健龙[1] 郭宽鹏[1] 聂波丽[1] 张林[1] 李梨萍[1] 

机构地区：[1]湖南省儿童医院检验科,湖南长沙410007

出　　处：《中华医院感染学杂志》2012年第18期3942-3944,共3页Chinese Journal of Nosocomiology

基　　金：湖南省科技厅课题(2008FJ3193)

摘　　要：目的了解人苍白杆菌败血症患儿的临床特点及病原菌耐药基因,为临床治疗提供指导。方法收集湖南省儿童医院2006年1月-2009年12月收治的人苍白杆菌败血症患儿的临床资料,留取菌种进行药敏试验和ampC/R基因检测。结果 163例人苍白杆菌败血症患儿以28d～3岁年龄段为主,占80.4%;大部分患儿伴有其他主要疾病及并发症,92.6%有明显发热,其中<3月龄年龄段出现发热症状比例明显低于≥3月龄年龄段,57.7%白细胞升高,66.3%C-反应蛋白(CRP)升高,天冬氨酸氨基转移酶升高例数显著高于丙氨酸氨基转移酶升高例数;人苍白杆菌对氨苄西林、哌拉西林、头孢一、二、三代、氨曲南等耐药率均>90.0%,对左氧氟沙星、亚胺培南、环丙沙星、阿米卡星敏感率均>90.0%;基因检测人苍白杆菌有ampC/R基因。结论人苍白杆菌可导致婴幼儿败血症,头孢吡肟是首选药物,重症患儿可用亚胺培南,加强抗菌药物使用的控制,防止更多的耐药基因在菌种中传播。OBJECTIVE To investigate the clinical characteristics of Ochrobactrum anthropi with which the children were infected and which results in septicemia and the drug resistant genes so as to guide clinical practice. METHODS The clinical data of the children with septicemia caused by O. anthropi who treated in Hunan Children＇ s Hospital from Jan 2006 to Dec 2009 were collected, the drug susceptibility testing and the AmpC/R genetic testing were carried out. RESULTS Of 163 children with O. anthropi septicemia, the children aged from 28 days to 3 years old were major population, accounting for 80.4%; most of the children were with other diseases and complications, 92.6 % of the children had obvious fever, the incidence of the fever was significantly lower in the children aged less than 3 months old than in those aged more than 3 months old, 57.7% of WBC and 66.3% of CRP were elevated, and the proportion of AST increased obviously higher than that of ALT; the drug resistance rates of the pathogenic bacteria to ampicillin, piperacillin, the first,second and third generation of cephalosporins, and aztreonam were higher than 90.0%, the drug susceptibility rates to levofloxacin, imipenem, ciprofloxacin, and amikacin were higher than 90.0%; the genetic testing indicated that there were ampC/R genes detected. CONCLUSION O. anthropi can cause the septicemia in infants, cefepime is the preferred drug and imipenem is for the infants with severe septicemia, it is necessary to strengthen the control of antibiotics so as to prevent transmission of the resistant genes in the strains.

关 键 词：儿童 败血症 人苍白杆菌 临床特点 AMPC酶 

分 类 号：R878[医药卫生—运动医学]