儿童急性骨髓炎常见病原菌分布及耐药性分析  

Distribution and Drug Resistance of Common Pathogens in Children with Acute Osteomyelitis

作　　者：郭菡 季泽娟[2] 高凯杰 裴保方 GUO Han;JI Ze-juan;GAO Kai-jie;PEI Bao-fang(Department of Pharmacy,Children's Hospital Affiliated of Zhengzhou University,Zhengzhou 450018,China;Department of Osteology,Children's Hospital Affiliated of Zhengzhou University,Zhengzhou 450018,China;Zhengzhou Key Laboratory of Children's Infection and Immunity,Children's Hospital Affiliated of Zhengzhou University,Zhengzhou 450018,China)

机构地区：[1]郑州大学附属儿童医院药学部,郑州450018 [2]郑州大学附属儿童医院骨科,郑州450018 [3]郑州大学附属儿童医院郑州市儿童感染与免疫重点实验室,郑州450018

出　　处：《中国合理用药探索》2023年第12期38-43,共6页Chinese Journal of Rational Drug Use

基　　金：河南省医学科技攻关联合共建项目(LHGJ20220714)。

摘　　要：目的:探讨儿童急性骨髓炎常见病原菌分布及耐药性特征,指导临床合理应用抗菌药物。方法:回顾性收集某院2017年1月~2021年12月收治的190例急性骨髓炎患儿的临床资料,包括患儿基本资料、病原菌分布及药敏试验结果,分析不同年龄段的病原菌分布、细菌耐药情况以及耐甲氧西林金黄色葡萄球菌(MRSA)检出情况。结果:190例急性骨髓炎患儿共检出198株菌株,包括革兰阳性菌160株(80.81%)、革兰阴性菌36株(18.18%)和真菌2株(1.01%)。革兰阳性菌中,排名前5位的病原菌是金黄色葡萄球菌(125株,63.13%)、表皮葡萄球菌(11株,5.56%)、肺炎链球菌(9株,4.55%)、人葡萄球菌(7株,3.54%)和无乳链球菌(3株,1.52%);革兰阴性菌以肺炎克雷伯菌、大肠埃希菌、沙门菌属和铜绿假单胞菌为主。患者年龄范围为13天~13岁,其中<3月龄组表皮葡萄球菌、肺炎克雷伯菌、大肠埃希菌检出占比高于≥3月龄组(P<0.05),≥3月龄组金黄色葡萄球菌检出占比高于<3月龄组(P<0.05)。金黄色葡萄球菌对青霉素、红霉素、克林霉素的耐药率分别为98.40%、86.40%和80.00%,对四环素、复方磺胺甲唑、利福平耐药率较低。未发现对万古霉素和利奈唑胺耐药菌株。MRSA检出率近5年略有下降,从2017~2019年的39.71%下降至2020~2021年的31.58%(P>0.05)。结论:金黄色葡萄球菌是该院儿童急性骨髓炎最常见的病原菌,MRSA检出率有下降趋势,临床治疗中应多次病原学送检,并根据药敏结果及时调整用药方案,在保证临床疗效的同时避免抗菌药物滥用和细菌耐药的产生。Objective:To investigate the distribution and drug resistance characteristics of common pathogens in children with acute osteomyelitis,and to provide guidelines on the rational use of antibiotics in clinic.Methods:The clinical data of 190 children with acute osteomyelitis admitted to a hospital from January 2017 to December 2021 were retrospectively analyzed,including the basic data of the children,the distribution of pathogenic bacteria and the results of bacterial drug sensitivity.The distribution of pathogenic bacteria at different ages,the status of bacterial drug resistance and the detection of methicillin-resistant Staphylococcus aureus(MRSA)were analyzed.Results:198 strains were detected in 190 children with acute osteomyelitis,of which 160(80.81%)were Gram-positive bacteria,36(18.18%)were Gram-negative bacteria and 2(1.01%)were fungi.Among the Gram-positive bacteria,the top 5 pathogens were Staphylococcus aureus(125 strains,63.13%),Staphylococcus epidermidis(11 strains,5.56%),Streptococcus pneumoniae(9 strains,4.55%),Staphylococcus hominis(7 strains,3.54%)and Streptococcus agalactiael(3 strains,1.52%).The Gram-negative bacteria were mainly Klebsiella pneumoniae,Escherichia coli,Salmonella and Pseudomonas aeruginosa.The age of patients ranged from 13 days to 13 years,and the proportion of Staphylococcus epidermidis,Klebsiella pneumoniae and Escherichia coli in the children<3 months age group was significantly higher than that in the children≥3 months age group.The difference was statistically significant(P<0.05),and the proportion of Staphylococcus aureus in the children≥3 months age group was significantly higher than that in the children<3 months age group.The difference was statistically significant(P<0.05).The resistance rate of Staphylococcus aureus to penicillin,erythromycin and clindamycin were 98.40%,86.40%and 80.00%,respectively.The resistance rate of Staphylococcus aureus to tetracycline,fixed dose compound sulfamethoxazole and rifampicin was low.No vancomycin and linezolidin-resistant strain

关 键 词：儿童 急性骨髓炎 病原菌 耐药性 金黄色葡萄球菌 

分 类 号：R726.8[医药卫生—儿科]