266例儿童急性骨髓炎病原学特点及抗菌药物应用分析  

Analysis of the Pathogenic Characteristics and Antimicrobial Utilization in 266 Children with Acute Osteomyelitis

作　　者：郭菡 季泽娟[2] 高凯杰 裴保方 GUO Han;JI Zejuan;GAO Kaijie;PEI Baofang(Department of Pharmacy,Children's Hospital Affiliated to Zhengzhou University,Zhengzhou 450018,China;Department of Osteology,Children's Hospital Affiliated to Zhengzhou University,Zhengzhou 450018,China;Key Laboratory of Children's Infection and Immunity,Children's Hospital Affiliated to 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儿童感染与免疫重点实验室,郑州450018

出　　处：《医药导报》2024年第2期283-287,共5页Herald of Medicine

基　　金：河南省医学科技攻关计划联合共建项目(LHGJ20220714)。

摘　　要：目的调查儿童急性骨髓炎病原学特点和抗菌药物使用情况,为临床合理用药提供参考。方法回顾性分析郑州大学附属儿童医院骨科2019年1月—2022年12月收治的266例儿童急性骨髓炎临床资料,统计患儿基本信息、病原微生物送检、药敏试验结果及抗菌药物使用情况。结果266例急性骨髓炎患儿均做病原学送检,148例培养出病原菌,检出阳性率为55.64%,共检出细菌154株,排名前3位的病原菌依次为金黄色葡萄球菌104株(67.53%)、表皮葡萄球菌8株(5.19%)和人葡萄球菌7株(4.55%)。耐甲氧西林金黄色葡萄球菌(MRSA)检出率为33.65%,与甲氧西林敏感金黄色葡萄球菌(MSSA)比较,MRSA感染患儿在疾病严重程度及治疗预后方面,差异无统计学意义。抗菌药物使用率为100.00%,经验性抗菌药物治疗单独用药227例,占85.34%,以头孢曲松为主,二联用药39例,占14.66%,以头孢曲松联合万古霉素为主,静脉用药平均疗程为(40.20±15.68)d。148例药敏结果报告后,治疗有效,继续原方案治疗76例(51.35%);治疗效果差,根据药敏结果调整用药37例(25.00%);药敏结果提示敏感,但疗效欠佳,更换药物25例(16.89%);临床治疗有效,根据药敏结果更换为窄谱抗菌药物或由二联改为单药治疗10例(6.76%)。结论儿童急性骨髓炎经验性抗菌药物治疗能够覆盖常见病原菌,结合临床疗效和药敏结果调整用药方案,但抗菌药物静脉用药疗程偏长,需进一步把握静脉用药序贯口服给药时机。Objective To investigate the pathogenic characteristics and use of antibiotics in children with acute osteomyelitis,and to provide evidence for rational drug use in the clinic.Methods The clinical data of 266 children with acute osteomyelitis admitted to the Department of Orthopedics,Children's Hospital Affiliated to Zhengzhou University from January 2019 to December 2022 were retrospectively analyzed,and the basic information,pathogenic microorganisms,drug sensitivity test results,and antibacterial drug use of the children were statistically analyzed.Results In 266 cases of pediatric acute osteomyelitis,all underwent pathogen examination,and 148 cases were cultured for pathogens with a positive detection rate of 55.64%.A total of 154 strains of bacteria were detected.The top three pathogens were Staphylococcus aureus(104 strains,67.53%),Staphylococcus epidermidis(8 strains,5.19%),and Staphylococcus hominis(7 strains,4.55%).The detection rate of methicillin-resistant Staphylococcus aureus(MRSA)was 33.65%.Compared with methicillin-sensitive Staphylococcus aureus(MSSA),there was no significant difference in disease severity and prognosis of infection with MRSA.The utilization rate of antibiotics was 100.00%;227 cases of empirical antibiotics were used alone,accounting for 85.34%,primarily using ceftriaxone.Combination therapy was used in 39 cases,accounting for 14.66%,mainly ceftriaxone combined with vancomycin;the average course of intravenous drugs was 40.20 days.After receiving the drug sensitivity test results in 148 cases,76 cases(51.35%)continued the original treatment plan due to effective treatment.In 37 cases(25.00%),treatment was adjusted based on the drug sensitivity results due to poor treatment outcomes;the drug sensitivity results indicated sensitivity,but the clinical effect was not good in 25 cases accounting for 16.89%,which changed the drug treatment.In 10 cases(6.76%),clinical treatment was effective,leading to a switch to narrow-spectrum antibiotics or a change from combination therapy to monoth

关 键 词：抗菌药物 急性骨髓炎/儿童 病原菌 

分 类 号：R978[医药卫生—药品] R726.8[医药卫生—药学]