儿童软组织感染病原菌分布及其耐药性  

Distribution and antimicrobial resistance of pathogens causing soft tissue 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 Tian-jiu;YU Song;YANG Xiao-hong;LV Xin;XU Yan-peng;LUO Yu(Affiliated Hospital of Zunyi Medical College,Zunyi 563003,China)

机构地区：[1]遵义医学院附属医院,贵州遵义563003

出　　处：《中国感染控制杂志》2018年第5期436-439,共4页Chinese Journal of Infection Control

摘　　要：目的探讨儿童软组织感染(STI)病原菌及其耐药性。方法分析某院2010年1月—2017年1月收治的细菌培养阳性的STI患儿,并分为社区STI组和医院感染STI组,对STI病原菌及其耐药性进行分析。结果共收治165例细菌培养阳性的STI患儿。社区STI组98例,医院感染STI组67例。共培养出细菌16种。98例社区STI均为单细菌感染,其中革兰阳性(G+)菌92株,主要为金黄色葡萄球菌(85株,86.7%)、化脓性链球菌(4株,4.08%);革兰阴性(G-)菌6株,主要为大肠埃希菌(3株,3.06%)、肺炎克雷伯菌(2株,2.04%)。医院感染STI组67例,5例为两种细菌混合感染,共培养出细菌72株,G+菌13株,主要为金黄色葡萄球菌(9株,12.50%);G-菌59株,主要为大肠埃希菌(21株,29.17%)、铜绿假单胞菌(15株,20.83%)、阴沟肠杆菌(13株,18.06%)。金黄色葡萄球菌对青霉素、红霉素、林可霉素耐药率>50%,对庆大霉素、复方磺胺甲口恶唑和利福平的耐药率<20%,耐甲氧西林金黄色葡萄球菌的检出率为43.62%,未发现对万古霉素、利奈唑胺、替加环素、左氧氟沙星、莫西沙星和呋喃妥因耐药菌株。大肠埃希菌对头孢呋辛、复方磺胺甲口恶唑的耐药率>70%,对哌拉西林、头孢吡肟和左氧氟沙星的耐药率<30%,未见对亚胺培南耐药的大肠埃希菌及铜绿假单胞菌菌株。结论儿童社区STI病原菌以金黄色葡萄球菌为主;医院感染STI病原菌以大肠埃希菌、铜绿假单胞菌、阴沟肠杆菌等G-菌为主。儿童STI在未明确病原菌之前,可根据感染的类型选择相应的抗菌药物。Objective To explore distribution and antimicrobial resistance of pathogens causing soft tissue infection(STI)in children.Methods Children with STI and had positive bacterial culture in a hospital between January 2010 and January 2017 were analyzed,they were divided into community-associated STI group(CA-STI)and healthcare-associated STI(HA-STI)group,pathogens and antimicrobial resistance of pathogens causing STI were analyzed.Results A total of 165 STI patients were with positive bacterial culture.There were 98 cases in CA-STI group and 67 in HA-STI group.16 kinds of bacteria were isolated.98 cases of CA-STI were single bacterial infection,92 of which were gram-positive bacteria,mainly Staphylococcus aureus(S.aureus,n=85,86.7%)and Streptococcus pyogenes(n=4,4.08%);6 strains were gram-negative bacteria,mainly Escherichia coli(E.coli,n=3,3.06%)and Klebsiella pneumoniae(n=2,2.04%).67 cases were HA-STI,5 cases were mixed infection with two kinds of bacteria,72 strains of bacteria were isolated,13 were gram-positive bacteria strains,mainly S.aureus(n=9,12.50%);59 were gram-negative bacteria,mainly E.coli(n=21,29.17%),Pseudomonas aeruginosa(P.aeruginosa,n=15,20.83%),and Enterobacter cloacae(E.cloacae,n=13,18.06%).Resistance rates of S.aureus to penicillin,erythromycin,and lincomycin were all>50%,resistance rates to gentamicin,compound sulfamethoxazole,and rifampicin were all<20%,isolation rate of methicillin-resistant S.aureus(MRSA)was 43.62%,strains were all sensitive to vancomycin,linezolid,tigecycline,levofloxacin,moxifloxacin,and nitrofurantoin.Resistance rates of E.coli to cefuroxime and sulfamethoxazole were all>70%,resistance rates to piperacillin,cefepime,and levofloxacin were all<30%,imipenem-resistant E.coli and P.aeruginosa were not found.Conclusion S.aureus is the main pathogen causing CA-STI in children;the main pathogens of HA-STI are E.coli,P.aeruginosa,E.cloacae,and other gram-negative bacteria.Children with STI can choose antimicrobial agents according to types of infection before pathogens are identi

关 键 词：儿童 软组织感染 病原菌 耐药性 抗药性 微生物 

分 类 号：R378[医药卫生—病原生物学]