儿童化脓性关节炎病原菌分布及耐药性分析  

Distribution and drug resistance of pathogenic bacteria in children with septic arthritis

作　　者：黎梓宇 李各芳[1] 何波[1] 张群[1] Li Ziyu;Li Gefang;He Bo;Zhang Qun(Department of Orthopedics,Children’s Hospital of Chongqing Medical University/National Clinical Research Center for Child Health and Disorders/Ministry of Education Key Laboratory of Child Development and Disorders/Chongqing Key Laboratory of Pediatrics)

机构地区：[1]重庆医科大学附属儿童医院骨科/国家儿童健康与疾病临床医学研究中心/儿童发育疾病研究教育部重点实验室/儿科学重庆市重点实验室,重庆400014

出　　处：《重庆医科大学学报》2024年第3期290-294,共5页Journal of Chongqing Medical University

基　　金：国家自然科学基金资助项目(编号:82072346)。

摘　　要：目的:分析171例儿童化脓性关节炎病原菌的分布及耐药性,为临床诊治提供依据。方法:回顾重庆医科大学附属儿童医院2012年1月至2022年12月化脓性关节炎患者的细菌培养及药敏试验结果,分析其病原菌分布及耐药性特点。结果:171例患者共检出病原菌82株,其中革兰氏阳性菌(Gram-positive G+)74株,革兰氏阴性菌(Gram-negative G-)8株。居前3位的细菌为金黄色葡萄球菌(54株,65.9%)、化脓性链球菌(7株,8.5%)、肺炎链球菌(5株,6.1%)。<2岁的患者主要病原菌为金黄色葡萄球菌和肺炎链球菌(15例,71.4%),2~5岁的患者主要病原菌为金黄色葡萄球菌(9例,81.8%),5岁以上的患者主要病原菌为金黄色葡萄球菌和化脓性链球菌(40例,88.9%)。所有G+对万古霉素和利奈唑胺耐药率0%,金黄色葡萄球菌对苯唑西林、阿莫西林/克拉维酸、头孢克洛、氟氯西林的耐药率<30%,化脓性链球菌对青霉素耐药率0%,肺炎链球菌对青霉素、头孢曲松耐药率20%。所有G-对头孢他啶、头孢吡肟、左氧氟沙星、环丙沙星、亚胺培南耐药率均为0%。结论:临床医师在治疗化脓性关节炎时可根据所在区域的主要病原菌及其耐药特点结合患者年龄分布特征选择适宜的抗菌药物。Objective:To analyze the distribution and drug resistance of pathogenic bacteria in 171 children with septic arthritis,and to provide a basis for clinical diagnosis and treatment.Methods:Based on bacterial culture and drug sensitivity test results,we analyzed the distribution and drug resistance of pathogenic bacteria in patients with septic arthritis in Children's Hospital of Chongqing Medical University from January 2012 to December 2022.Results:A total of 82 strains of pathogenic bacteria were detected in 171patients,including 74 Gram-positive(G+) and 8 Gram-negative strains(G-).The top three bacteria were Staphylococcus aureus(54strains,65.9%),Streptococcus pyogenes(7 strains,8.5%),and Streptococcus pneumoniae(5 strains,6.1%).The predominant pathogens were Staphylococcus aureus and Streptococcus pneumoniae in patients under two years of age(15 cases,71.4%),Staphylococcus aureus in patients between two and five years of age(9 cases,81.8%),and Staphylococcus aureus and Streptococcus pyogenes in patients over five years of age(40 cases,88.9%).For all G+ bacteria,the rates of resistance to vancomycin and linezolid were 0%.The resistance rates of Staphylococcus aureus to benzoxacillin,amoxicillin/clavulanic acid,cefaclor,and flucloxacillin were <30%.The resistance rate of Streptococcus pyogenes to penicillin was 0%.Streptococcus pneumoniae was 20% resistant to penicillin and ceftriaxone.All G-bacteria were 0% resistant to ceftazidime,cefepime,levofloxacin,ciprofloxacin,and imipenem.Conclusion:Clinicians should choose appropri-ate antimicrobial drugs to treat septic arthritis according to the main pathogens and their resistance characteristics in local regions as well as the age distribution of patients.

关 键 词：儿童 化脓性关节炎 病原菌 耐药性分析 

分 类 号：R915.11[医药卫生—微生物与生化药学]