摘要
目的总结儿童骨关节化脓性感染的致病菌类型及其耐药情况,为临床合理使用抗生素提供参考,同时探讨患儿入院时炎性指标对骨关节化脓性感染致病菌及其耐药情况有无提示作用。方法收集89例骨关节化脓性感染患儿的脓液和静脉血标本,各89份,分别进行细菌培养鉴定和药物敏感试验,并分析其结果,比较以金黄色葡萄球菌为致病菌的不同疾病类型的耐甲氧西林金黄色葡萄球菌(MRSA)感染情况。所有患儿均给予检测炎性指标[白细胞计数(WBC)、C反应蛋白(CRP)、血沉(ESR)、降钙素],比较MRSA(+)与MRSA(-)感染患儿、耐药菌与非耐药菌感染患儿入院时炎性指标水平。结果89例患儿共培养出11种细菌。主要以金黄色葡萄球菌为主,有63例(70.79%)。63株金黄色葡萄球菌中有24株为MRSA,表皮葡萄球菌4株均为耐甲氧西林凝固酶阴性葡萄球菌(MRSCN),人葡萄球菌4株中2株为MRSCN。MRSA及MRSCN均对万古霉素及利奈唑胺敏感,未发现对万古霉素耐药的菌株。以金黄色葡萄球菌为致病菌的骨髓炎、化脓性关节炎、骨髓炎合并化脓性关节炎中MRSA感染所占比例分别为55.56%、26.32%、57.14%,比较差异具有统计学意义(P<0.05);两两比较差异无统计学意义(P>0.0167)。MRSA(+)与MRSA(-)感染患儿CRP水平比较,差异有统计学意义(P<0.05);MRSA(+)与MRSA(-)感染患儿WBC、ESR、降钙素水平比较,差异无统计学意义(P>0.05)。耐药菌与非耐药菌感染患儿CRP水平比较,差异有统计学意义(P<0.05);耐药菌与非耐药菌感染感染患儿WBC、ESR、降钙素水平比较,差异无统计学意义(P>0.05)。结论儿童骨关节化脓性感染致病菌以金黄色葡萄球菌为主,伴随着严格控制抗生素应用指征,避免抗生素滥用。本地区MRSA感染有减少的趋势。当骨关节化脓性感染致病菌为MRSA时,患儿出现骨髓炎、化脓性关节炎、骨髓炎合并化脓性关节炎的几率不同。CRP水平显著
Objective To summarize the types of pathogenic bacteria and their drug resistance in children with suppurative bone and joint infections,to provide references for rational use of antibiotics in clinic,and to explore whether inflammatory indicators can indicate the pathogenic bacteria and drug resistance in children with suppurative bone and joint infections at admission.Methods Pus and venous blood samples from 89 children with suppurative bone and joint infections were collected.Bacterial culture and drug susceptibility tests were performed on 89 specimens respectively.The results were analyzed and the infection status of methicillin-resistant Staphylococcus aureus(MRSA)in different disease types with Staphylococcus aureus as pathogen was compared.Inflammatory markers(white blood cell(WBC)count,C-reactive protein(CRP),erythrocyte sedimentation rate(ESR)and calcitonin)were detected in all children.The levels of inflammatory markers were compared between MRSA(+)and MRSA(-)infected children,drug-resistant bacteria and nondrug-resistant bacteria infected children at admission.Results A total of 11 kinds of bacteria were cultured from 89 children,mainly Staphylococcus aureus as 63 cases(70.79%).24 strains were MRSA in 63 strains of Staphylococcus aureus,4 strains of Staphylococcus epidermidis were methicillin-resistant coagulase-negative staphylococci(MRSCN),and 2 strains were MRSCN in 4 strains of Staphylococcus aureus.MRSA and MRSCN were sensitive to vancomycin and linezolid,and no strain resistant to vancomycin was found.The proportion of MRSA infection in osteomyelitis,pyogenic arthritis and osteomyelitis with pyogenic arthritis caused by Staphylococcus aureus was 55.56%,26.32%and 57.14%,respectively,and the difference was statistically significant(P<0.05);there was no significant difference in pairwise comparison(P>0.0167).The difference in CRP level between MRSA (+) and MRSA (-) infected children was statistically significant (P<0.05);the difference in WBC, ESR and calcitoninbetween MRSA (+) and MRSA (-) infect
作者
刘仕哲
付桂兵
唐盛平
LIU Shi-zhe;FU Gui-bing;TANG Sheng-ping(Department of Orthopedics,Shenzhen Children’s Hospital,Shenzhen 518000,China)
出处
《中国现代药物应用》
2019年第16期11-14,共4页
Chinese Journal of Modern Drug Application
关键词
骨关节
化脓性感染
致病菌
耐药性
儿童
Bone and joint
Suppurative infection
Pathogens
Drug resistance
Children
