小儿消化道穿孔合并腹膜炎的感染状况及耐药性分析
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摘要
目的分析小儿消化道穿孔合并腹膜炎患者的感染状况及耐药性状况,为患儿的临床诊疗提供指导。方法将廉江市妇幼保健院小儿外科2017年8月至2018年8月收治的65例消化道穿孔合并腹膜炎患儿作为研究对象。采用全自动细菌鉴定系统对采集的腹腔积液进行判定,同时,应用药敏分析系统对培养后的细菌进行耐药性分析。结果坏死性小肠结肠炎及肠坏死穿孔革兰阴性杆菌分布较广,分布率分别为59.1%和65.5%,而肠套叠及重症急性胰腺炎革兰阳性球菌分布较广,分布率分别为75.0%和60.0%;在所有原发病中,真菌分布率较低;大肠埃希菌、肠杆菌、肺炎克雷伯菌对阿莫西林耐药率均为100.0%,对亚胺培南、哌拉西林/他唑巴坦耐药率分别为0、0和12.5%,而凝固酶阴性葡萄球菌、粪肠球菌及金黄色葡萄球菌对替考拉宁、万古霉素均无耐药性,对苯唑西林耐药率分别为88.9%、100.0%和60.0%。结论革兰阴性杆菌是消化道穿孔合并腹膜炎的主要致病菌,革兰阳性球菌次之。革兰阴性杆菌对亚胺培南、哌拉西林/他唑巴坦耐药性低,对阿莫西林完全耐药。革兰阳性球菌对苯唑西林等耐药性较高,而对替考拉宁、万古霉素均无耐药性。
Objective To study infection status and drug resistance in children with gastrointestinal perforation combined with peritonitis, in order to provide guidance for clinical diagnosis and treatment of children. Methods Sixty-five children with gastrointestinal perforation combined with peritonitis in Department of Pediatric Surgery, Lianjiang Maternal and Child Health Hospital from August 2017 to August 2018 were enrolled in the study. Hydrocele was determined by automatic bacterial identification system, and drug resistance of bacteria was analyzed. Results Distribution of Gram-negative bacillus was wider in necrotizing enterocolitis and intestinal necrotic perforation, with the distribution rates of 59.1% and 65.5%, respectively, while distribution of Gram-positive cocci was wider in intussusception and severe acute pancreatitis, with the distribution rates of 75.0% and 60.0%. The distribution rate of fungi was low. The resistance rates of E. coli, Enterobacter spp, and Klebsiella pneumoniae to amoxicillin were all 100.0%, and their resistance rates to imipenem, piperacillin/tazobactam were 0, 0, and 12.5%, respectively. Coagulase-negative staphylococcus, Enterococcus faecalis, and Staphylococcus aureus were not resistant to teicoplanin and vancomycin. The resistance rates to oxacillin were 88.9%, 100.0%, and 60.0%, respectively. Conclusion Gram-negative bacilli are the main pathogens of gastrointestinal perforation complicating peritonitis, followed by Gram-positive cocci. Gram-negative bacilli showed low resistance to imipenem, piperacillin/tazobactam and complete resistance to amoxicillin. Gram-positive cocci showed high resistance to oxacillin, but were not resistant to teicoplanin or vancomycin.
Objective To study infection status and drug resistance in children with gastrointestinal perforation combined with peritonitis, in order to provide guidance for clinical diagnosis and treatment of children. Methods Sixty-five children with gastrointestinal perforation combined with peritonitis in Department of Pediatric Surgery, Lianjiang Maternal and Child Health Hospital from August 2017 to August 2018 were enrolled in the study. Hydrocele was determined by automatic bacterial identification system, and drug resistance of bacteria was analyzed. Results Distribution of Gram-negative bacillus was wider in necrotizing enterocolitis and intestinal necrotic perforation, with the distribution rates of 59.1% and 65.5%, respectively, while distribution of Gram-positive cocci was wider in intussusception and severe acute pancreatitis, with the distribution rates of 75.0% and 60.0%. The distribution rate of fungi was low. The resistance rates of E. coli, Enterobacter spp, and Klebsiella pneumoniae to amoxicillin were all 100.0%, and their resistance rates to imipenem, piperacillin/tazobactam were 0, 0, and 12.5%, respectively. Coagulase-negative staphylococcus, Enterococcus faecalis, and Staphylococcus aureus were not resistant to teicoplanin and vancomycin. The resistance rates to oxacillin were 88.9%, 100.0%, and 60.0%, respectively. Conclusion Gram-negative bacilli are the main pathogens of gastrointestinal perforation complicating peritonitis, followed by Gram-positive cocci. Gram-negative bacilli showed low resistance to imipenem, piperacillin/tazobactam and complete resistance to amoxicillin. Gram-positive cocci showed high resistance to oxacillin, but were not resistant to teicoplanin or vancomycin.
引文
[1]朱真闯,闫学强,杨俊,等.小儿误食异物致消化道穿孔12例诊治分析[J].北京大学学报(医学版), 2017, 49(5):924-926.
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[9] ADASHEK M, CHAN A, MEDINA A. Gastrointestinal Perforation after rituximab therapy in mantle cell lymphoma:a case report[J].Case Rep Oncol, 2018, 11(3):784-790.
[10]刘庆倩,舒啸尘.革兰阴性菌所致腹膜透析相关性腹膜炎的耐药性及影响因素研究[J].中国全科医学, 2018, 21(30):3700-3703.
[11]吴小漫,邓丽萍,麦美芳,等.腹膜透析相关性腹膜炎患者病原菌及相关因素分析[J].中华医院感染学杂志, 2018, 28(19):2944-2947.
[12]韩杰,张芙蓉. 78例消化道穿孔并发腹膜炎患儿病原菌分布及抗菌药物敏感性分析[J].山东医药, 2017, 57(24):66-68.
[13]郑达武,罗永香,江款,等.哌拉西林/他唑巴坦联合微生态制剂治疗肝硬化合并自发性细菌性腹膜炎的临床疗效及对肝功能及炎性因子的影响[J].中华医院感染学杂志, 2018, 28(23):3544-3548.
[14] ZHANG R, XU Z, YAO J, et al. Tuberculous peritonitis diagnosed using laparoscopy with assistance of a central venous catheter[J]. Exp Ther Med, 2018, 16(6):5265-5271.
[15]顾君娣,陆佳敏,江军,等.肝硬化腹水患者合并自发性细菌性腹膜炎病原菌及相关因素分析[J].中华医院感染学杂志, 2018, 28(19):2940-2943.
[16]张灵灵,郭利芹,陶瑾,等.肠道感染所致腹膜透析患者相关性腹膜炎致病菌及耐药性分析[J].中华医院感染学杂志, 2018, 28(24):3767-3770.
[2]章俊,王悦,梁秀洁,等.复发和再发性腹膜透析相关性腹膜炎的危险因素及致病菌特征[J].广东医学, 2016, 37(4):602-605.
[3]肖迪,宋红霞.细菌性腹膜炎患者腹水分离大肠埃希菌耐药性分析[J].中国消毒学杂志, 2016, 33(7):706-708.
[4] AKBULUT S, KOC C, DIRICAN A. Unusual complication in patient with Gardner's syndrome:coexistence of triple gastrointestinal perforation and lower gastrointestinal bleeding:a case report and review of literature[J]. World J Clin Cases, 2018, 6(10):393-397.
[5]皮明婧,蒋文勇,达静静,等.老年腹膜透析相关性腹膜炎病原菌及耐药性[J].中国老年学杂志, 2018, 38(14):3429-3431.
[6]唐鲁静,赵泓,楼金玕,等.儿童上消化道异物致消化道损伤217例回顾性分析[J].中国当代儿科杂志, 2018, 20(7):567-571.
[7] MITSUI E, INABA M, MIMURA T. Peritonitis with small intestinal perforation caused by a plastic bread bag clip:a case report[J]. Int J Surg Case Rep, 2018, 51(10):130-133.
[8]杨丽,龚妮容,刘宏发,等.腹膜透析相关性腹膜炎的细菌谱及耐药性分析[J].肾脏病与透析肾移植杂志, 2018, 27(6):513-517.
[9] ADASHEK M, CHAN A, MEDINA A. Gastrointestinal Perforation after rituximab therapy in mantle cell lymphoma:a case report[J].Case Rep Oncol, 2018, 11(3):784-790.
[10]刘庆倩,舒啸尘.革兰阴性菌所致腹膜透析相关性腹膜炎的耐药性及影响因素研究[J].中国全科医学, 2018, 21(30):3700-3703.
[11]吴小漫,邓丽萍,麦美芳,等.腹膜透析相关性腹膜炎患者病原菌及相关因素分析[J].中华医院感染学杂志, 2018, 28(19):2944-2947.
[12]韩杰,张芙蓉. 78例消化道穿孔并发腹膜炎患儿病原菌分布及抗菌药物敏感性分析[J].山东医药, 2017, 57(24):66-68.
[13]郑达武,罗永香,江款,等.哌拉西林/他唑巴坦联合微生态制剂治疗肝硬化合并自发性细菌性腹膜炎的临床疗效及对肝功能及炎性因子的影响[J].中华医院感染学杂志, 2018, 28(23):3544-3548.
[14] ZHANG R, XU Z, YAO J, et al. Tuberculous peritonitis diagnosed using laparoscopy with assistance of a central venous catheter[J]. Exp Ther Med, 2018, 16(6):5265-5271.
[15]顾君娣,陆佳敏,江军,等.肝硬化腹水患者合并自发性细菌性腹膜炎病原菌及相关因素分析[J].中华医院感染学杂志, 2018, 28(19):2940-2943.
[16]张灵灵,郭利芹,陶瑾,等.肠道感染所致腹膜透析患者相关性腹膜炎致病菌及耐药性分析[J].中华医院感染学杂志, 2018, 28(24):3767-3770.