儿童医院获得性血流感染的临床特征和病原学分析  

Analysis of etiology and clinical features of hospital-acquired bloodstream infection in children

作　　者：徐月波[1] 董琳[1] 刘琳[1] 蔡蓓蓓[1] 

机构地区：[1]温州医学院附属育英儿童医院呼吸科,325027

出　　处：《中华传染病杂志》2013年第4期221-226,共6页Chinese Journal of Infectious Diseases

摘　　要：目的分析儿童医院获得性血流感染（HABSI）的病原菌分布及其耐药性，为临床抗感染治疗提供依据。方法回顾性分析温州医学院附属育英儿童医院2004年1月至2011年12月收治的168例病原学阳性的HABSI患儿的临床和细菌药物敏感试验资料。结果共从168例患儿中检出病原菌171株，以ICU最多见（73．7oA），其次为血液科（22．6％）。其中革兰阳性菌占53．8％，革兰阴性菌占34．5％，真菌占11．7％；居前6位的分别为表皮葡萄球菌（24株、14．1％），肺炎克雷伯菌（23株、13．5％），溶血葡萄球菌（13株、7．6%），金黄色葡萄球菌（11株、6．4％），屎肠球菌（11株、6．4%）及大肠埃希菌（11株、6．4％）。检出耐甲氧西林金黄色葡萄球菌和耐甲氧西林表皮葡萄球菌分别为1株和22株，未发现耐万古霉素和耐利奈唑胺的葡萄球菌和肠球菌。肺炎克雷伯菌和大肠埃希菌产超广谱β-内酰胺酶（ESBL）株分别有22株和8株。160例（95．2％）患儿原有基础疾病，以早产和低体质量最多见（60．7％），126例（75．0％）接受过侵入性操作。发病年龄以〈3个月最多见（75．6％）。结论HABSI好发于3个月以下婴儿及有基础疾病的患儿，多数接受过侵入性操作；病原菌以革兰阳性球菌为主；极低出生体质量儿可发生罕见的奥默毕赤酵母菌HABSI，加强医院感染防控至关重要。Objective To summarize the pathogenic spectrum and antimicrobial susceptibility of hospital-acquired bloodstream infections （HABSI） in children,and to provide evidence for clinical anti- infection treatment. Methods During January 2004 to December 2011, the clinical data and drug susceptibility results of 168 children who were diagnosed with HABSI based on positive results of pathogen tests were reviewed retrospectively in Yuying Children＇s Hospital affiliated to Wenzhou Medical College. Results A total of 171 strains were isolated from blood specimens of the 168 children. The majority of HABSI occurred in the intensive care unit （73.7 0%）, followed by department of hematology （22. 6%）. Gram-positive bacteria, gram-negative bacteria and fungi accounted for 53.8%, 34.5% and 11.7%, respectively. The predominant pathogens were Stagphylococcus epidermidis （14. 1%）, followed by Klebsiella pneumonia （ 13. 5 %）, Staphylococcus haemol yticus （7.6%）, Staphylococcus aureus （6.4%）, Enterococcus faecium （6.4%） and Escherichia coli （6.4 % ）. Staphylococcus aureus and Staphylococcus epidermidis resistant to methicillin were detected in 9.1 % and 91.7% of specimens, respectively. Staphylococcus and enterococcus which were resistantto vancomycin or linezolid were not detected. The isolation rates of Klebsiella pneumoniae and Escherichia coli with extended-spectrum beta-lactamases （ESBL） were 95.7% and 72. 7%, respectively. One hundred and sixty cases （95.2 %） had underlying diseases including premature birth and low birth weight （60. 7%）. One hundred and twenty-six cases （75. 0%） underwent invasive procedures. The peak incidence of HABSI occurred in children less than 3 months old （75.6%）. Conclusions HABSI is most common in infants younger than 3 months old, with underlying diseases or undergone invasive procedures. The pathogens are mainly gram-positive bacteria. Very low birth weight infants can acquire unusual infection of Kodamaea ohmeri. Thus, it is essential to str

关 键 词：菌血症 交叉感染 革兰阳性球菌 毕赤酵母 微生物敏感性试验 抗药性 微生 物 儿童 

分 类 号：R446.5[医药卫生—诊断学]