儿童血源性骨关节感染中金黄色葡萄球菌耐药性分析  

Analysis of drug resistance of Staphylococcus aureus in bone and joint infection in children

作　　者：张天久[1] 俞松[1] 杨小红[1] 吕欣[1] 徐艳朋[1] 罗宇[1] Zhang Tianjiu;Yu Song;Yang Xiaohong;Lyu Xin;Xu Yanpeng;Luo Yu(Department of Pediatric Orthopedics ,the Affiliated Hospital of Zunyi Medical College ,Zunyi 563003, Guizhou Province, Chin)

机构地区：[1]遵义医学院附属医院小儿骨科,563003

出　　处：《中华实用儿科临床杂志》2018年第11期828-830,共3页Chinese Journal of Applied Clinical Pediatrics

摘　　要：目的探讨遵义地区儿童血源性骨关节感染中金黄色葡萄球菌（SA）的耐药性及其变化情况。方法回顾性分析2008年1月至2016年12月遵义医学院附属医院收治的因SA导致骨关节感染的95例患儿临床资料。年龄10 d～14岁，平均5.6岁；男53例，女42例；急性骨髓炎39例，急性化脓性关节炎31例，慢性骨髓炎19例，同时有急性骨髓炎和关节炎6例。根据药敏结果，统计SA耐药性，比较耐甲氧西林金黄色葡萄球菌（MRSA）在不同性别和不同时间段的检出率及SA对其他抗菌药物的耐药性变化情况。结果95例SA导致的骨关节感染患儿中MRSA占50.53%（48例），对青霉素耐药率为92.63%（88例），对林可霉素、红霉素、头孢西丁和四环素耐药率分别为64.21%（61例）、57.90%（55例）、55.79%（53例）和53.68%（51例），对复方磺胺甲唑、庆大霉素和利福平的耐药率较低，分别为25.26%（24例）、11.58%（11例）和6.32%（6例），未发现对利奈唑胺、莫西沙星、替加环素、万古霉素、呋喃妥因耐药菌株。MRSA在男性患儿中的检出率（52.83%，28/53例）稍高于女性患儿（47.62%，20/42例），差异无统计学意义（χ2=0.255，P〉0.05）。2008年至2010年、2011年至2013年和2014年至2016年MRSA检出率分别为27.78%（5/18例）、51.61%（16/31例）和58.70%（27/46例），2014年至2016年MRSA检出率明显高于2008年至2010年，差异有统计学意义（χ2=4.95，P〈0.05）。SA对林可霉素、红霉素和头孢西丁的耐药率在2014年至2016年明显高于2008年至2010年，差异均有统计学意义（均P〈0.05）。结论遵义地区儿童血源性骨关节感染病例中SA耐药性较高，MRSA的检出率和SA对多种抗菌药物的耐药性有逐渐增加趋势。ObjectiveTo investigate the drug resistance and its changes of Staphylococcus aureus （SA） in children with bone and joint infection caused by hematogenous dissemination in Zunyi area.MethodsA retrospective study was performed on the clinical data of 95 cases with bone and joint infections caused by SA from January 2008 to December 2016 in the Affiliated Hospital of Zunyi Medical College, in which there were 53 boys and 42 girls with a mean age of 5.6 years（ranging from 10 days to 14 years）, including 39 cases of acute osteomyelitis, 31 cases of acute suppurative arthritis, 19 cases of chronic osteomyelitis, and 6 cases of acute osteomyelitis and arthritis.According to the results of drug sensitivity, the drug resistance of SA was analyzed, and the detection rates of Methicillin resistant Staphylococcus aureus （MRSA） were compared in different genders and timeframes, and the drug resistance of SA to other antibiotics were also analyzed.ResultsThe detection rate of MRSA was 50.53%（48 cases） in 95 cases, the resistance rate to Penicillin was 92.63%（88 cases）, and to Lincomycin, Erythromycin, Tetracycline and Cefoxitin were 64.21%（61 cases）, 57.90%（55 cases）, 55.79%（53 cases） and 53.68%（51 cases） respectively, but to Sulfamethoxazole Co., Gentamicin and Rifampicin it was relatively low[25.26%（24 cases）, 11.58%（11 cases）, 6.32%（6 cases） respectively], while the resistance to Moxifloxacin, Linezolid, Tigecycline, Vancomycin and Nitrofurantoin was not found.The detection rate of MRSA in boys（52.83%, 28/53 cases） was slightly higher than that of girls（47.62%, 20/42 cases）, but the difference was not statistically significant （χ2=0.255, P〉0.05）. The detection rates of MRSA in 2008-2010, 2011-2013 and 2014-2016 were 27.78%（5/18 cases）, 51.61%（16/31 cases） and 58.70%（27/46 cases） respectively, and it was obviously higher in 2014-2016 than in 2008-2010, and the difference was statistically significant （χ2=4.95, P〈0.05）. The drug resistance rate

关 键 词：儿童 骨关节感染 金黄色葡萄球菌 耐药性 

分 类 号：R378.11[医药卫生—病原生物学]