婴儿髋关节化脓性关节炎的病原菌耐药性分析
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摘要
目的研究婴儿髋关节化脓性关节炎的致病菌及耐药性。方法收治的髋关节化脓性关节炎患儿38例,进行回顾性分析。应用抗生素前在无菌操作下抽取患者脓液行细菌培养及药物敏感试验,并对细菌培养及药物敏感试验结果进行分析。结果分离出的43株阳性病原菌中,革兰阳性菌有25株,金黄色葡萄球菌最多见,革兰阴性菌有15株,其中以肺炎克雷伯杆菌为主,真菌3株。药敏试验结果显示革兰阳性菌均对万古霉素、替考拉宁、利奈唑胺敏感,高达100%,其中金黄色葡萄球菌对青霉素的耐药性最高,达93%;革兰阴性菌对美罗培南和亚胺培南高度敏感,肺炎克雷伯杆菌和大肠埃希菌还对喹诺酮类、部分β-内酰胺酶抑制剂具有较高的敏感性。结论对患有髋关节化脓性关节炎的婴儿,应注意留取病原学标本进行药物敏感试验分析,获得可靠的病原学诊断及药物敏感试验结果后改用敏感药物治疗,对减少细菌耐药性的产生具有重要作用。
Objective To investigate the pathogens and drug resistance of pathogens in infants with pyogemc arthritis of hip. Methods The data about 38 infants with septic arthritis of hip who were admitted and treated in our hospital from May2011 to August 2017 were retrospectively analyzed. The bacterial culture and drug sensitivity test were performed,and the results were analyzed. Results Among 43 strains of isolated pathogenic bacteria,there were 25 strains of gram positive bacteria,with staphylococcus aureus being the most,there were 15 strains of gram negative bacteria,in which,the klebsiella pneumoniae was the most,and there were 3 strains of fungi. The drug sensitive test showed that gram-positive bacteria were highly sensitive to vancomycin,teicoplanin and linezolid,reaching up to 100%. The staphylococcus aureus was the most resistant to penicillin,reaching up to 93%. The gram-negative were highly sensitive to meropenem and imipenem,moreover,the klebsiella pneumoniae and Escherichia coli were also highly sensitive to quinolones and some beta lactamase inhibitors.Conclusion For the infants with septic arthritis of hip,it should be paid much attention to taking pathogenic specimens for drug sensitivity test to obtain reliable etiological diagnosis and drug sensitivity test results,then to use sensitive antibiotic drugs,and it is important to reduce the creation of bacterial drug resistance.
Objective To investigate the pathogens and drug resistance of pathogens in infants with pyogemc arthritis of hip. Methods The data about 38 infants with septic arthritis of hip who were admitted and treated in our hospital from May2011 to August 2017 were retrospectively analyzed. The bacterial culture and drug sensitivity test were performed,and the results were analyzed. Results Among 43 strains of isolated pathogenic bacteria,there were 25 strains of gram positive bacteria,with staphylococcus aureus being the most,there were 15 strains of gram negative bacteria,in which,the klebsiella pneumoniae was the most,and there were 3 strains of fungi. The drug sensitive test showed that gram-positive bacteria were highly sensitive to vancomycin,teicoplanin and linezolid,reaching up to 100%. The staphylococcus aureus was the most resistant to penicillin,reaching up to 93%. The gram-negative were highly sensitive to meropenem and imipenem,moreover,the klebsiella pneumoniae and Escherichia coli were also highly sensitive to quinolones and some beta lactamase inhibitors.Conclusion For the infants with septic arthritis of hip,it should be paid much attention to taking pathogenic specimens for drug sensitivity test to obtain reliable etiological diagnosis and drug sensitivity test results,then to use sensitive antibiotic drugs,and it is important to reduce the creation of bacterial drug resistance.
引文
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2 张先慧,谭慧英.小儿骨关节感染研究的新进展.中国矫形外科杂志,2014,22:332-336.
3 应灏,焦勤.72例儿童骨与关节化脓性感染的临床分析.中华医院感染学杂志,2004,14:1013-1015.
4 戴春娟,叶祖萍,胡博,等.新生儿皮肤软组织感染中金黄色葡萄球菌耐药性分析.中国实用医药,2008,3:29-30.
5 Garcíaarias M,Balsa A,Mola EM.Septic arthritis.Best Pract Res Clin Rheumatol,2011,25:407-421.
6 Brischetto A,Leung G,Marshall CS,et al.A retrospective Case-Series of children with bone and joint infection from northern Australia.Medicine,2016,95:e2885.
7 Young TP,Maas L,Thorp AW,et al.Etiology of septic arthritis in children:an update for the new millennium.American Journal of Emergency Medicine,2011,29:899-902.
8 Miyahara HD,Helito CP,Oliva GB,et al.Clinical and epidemiological characteristics of septic arthritis of the hip,2006 to 2012,a seven-year review.Clinics,2014,69:464-468.
9 徐宏文,黎艺强,周庆和,等.新生儿化脓性关节炎治疗方式的选择.中华小儿外科杂志,2016,37:582-588.
10 金斌,孙军.6月龄以下婴儿化脓性髋关节炎诊疗分析.临床小儿外科杂志,2015,14:316-318.
11 Faust SN,Clark J,Pallett A,et al.Managing bone and joint infection in children.Arch Dis Child,2012,97:U92-545.
12 Thomsen I,Creech CB.Advances in the diagnosis and management of pediatric osteomyelitis.Curr Infect Dis Rep,2011,13:451-460.
13 Campoccia D,Montanaro L,Speziale P,et al.Antibiotic-loaded biomaterials and the risks for the spread of antibiotic resistance following their prophylactic and therapeutic clinical use.Biomaterials,2010,31:6363-6377.
14 Harik NS,Smeltzer MS.Management of acute hematogenous osteomyelitis in children.Expert Rev Anti Infect Ther,2010,8:175-181.
15 Peltola H,Pkk9nen M.Acute osteomyelitis in children.N Engl J Med,2014,370:352-360.
2 张先慧,谭慧英.小儿骨关节感染研究的新进展.中国矫形外科杂志,2014,22:332-336.
3 应灏,焦勤.72例儿童骨与关节化脓性感染的临床分析.中华医院感染学杂志,2004,14:1013-1015.
4 戴春娟,叶祖萍,胡博,等.新生儿皮肤软组织感染中金黄色葡萄球菌耐药性分析.中国实用医药,2008,3:29-30.
5 Garcíaarias M,Balsa A,Mola EM.Septic arthritis.Best Pract Res Clin Rheumatol,2011,25:407-421.
6 Brischetto A,Leung G,Marshall CS,et al.A retrospective Case-Series of children with bone and joint infection from northern Australia.Medicine,2016,95:e2885.
7 Young TP,Maas L,Thorp AW,et al.Etiology of septic arthritis in children:an update for the new millennium.American Journal of Emergency Medicine,2011,29:899-902.
8 Miyahara HD,Helito CP,Oliva GB,et al.Clinical and epidemiological characteristics of septic arthritis of the hip,2006 to 2012,a seven-year review.Clinics,2014,69:464-468.
9 徐宏文,黎艺强,周庆和,等.新生儿化脓性关节炎治疗方式的选择.中华小儿外科杂志,2016,37:582-588.
10 金斌,孙军.6月龄以下婴儿化脓性髋关节炎诊疗分析.临床小儿外科杂志,2015,14:316-318.
11 Faust SN,Clark J,Pallett A,et al.Managing bone and joint infection in children.Arch Dis Child,2012,97:U92-545.
12 Thomsen I,Creech CB.Advances in the diagnosis and management of pediatric osteomyelitis.Curr Infect Dis Rep,2011,13:451-460.
13 Campoccia D,Montanaro L,Speziale P,et al.Antibiotic-loaded biomaterials and the risks for the spread of antibiotic resistance following their prophylactic and therapeutic clinical use.Biomaterials,2010,31:6363-6377.
14 Harik NS,Smeltzer MS.Management of acute hematogenous osteomyelitis in children.Expert Rev Anti Infect Ther,2010,8:175-181.
15 Peltola H,Pkk9nen M.Acute osteomyelitis in children.N Engl J Med,2014,370:352-360.