婴幼儿非发酵菌感染的临床特征和耐药分析

doi:10.13481/j.1671-587x.20170522

吉林大学学报(医学版) ›› 2017, Vol. 43 ›› Issue (05): 975-979.doi: 10.13481/j.1671-587x.20170522

婴幼儿非发酵菌感染的临床特征和耐药分析

周浩泉¹, 储新民², 戴媛媛², 代传林¹, 潘家华¹

1. 安徽医科大学附属省立医院儿科, 安徽合肥 230001;
2. 安徽医科大学附属省立医院检验科, 安徽合肥 230001

收稿日期:2016-12-29 出版日期:2017-09-28 发布日期:2017-09-29
通讯作者: 潘家华,主任医师,教授,硕士研究生导师(Tel:0551-62283910,E-mail:zhouhq2005@qq.com) E-mail:zhouhq2005@qq.com
作者简介:周浩泉(1968-),男,安徽省萧县人,副主任医师,医学硕士,主要从事儿童呼吸病和感染病学方面的研究。
基金资助:
国家自然科学基金青年基金资助课题（81101312）

Clinical characteristics and drug resistance analysis of non-fermentative bacteria infection in infants

ZHOU Haoquan¹, CHU Xinmin², DAI Yuanyuan², DAI Chuanlin¹, PAN Jiahua¹

1. Department of Pediatrics, Anhui Provincial Hospital, Anhui Medical University, Hefei 230001, China;
2. Deparment of Laboratory, Anhui Provincial Hospital, Anhui Medical University, Hefei 230001, China

Received:2016-12-29 Online:2017-09-28 Published:2017-09-29

摘要/Abstract

摘要： 目的：对婴幼儿非发酵菌感染的临床特征和病情转归进行研究，分析感染婴幼儿非发酵菌的耐药情况，为医师识别非发酵菌感染的临床特征和及时治疗提供参考依据。方法：收集本院儿科各病区91例非发酵菌感染患儿资料，回顾性分析患儿基本临床资料及病情转归，检测非发酵菌菌株分布及耐药情况，并采用PCR法检测细菌耐药基因，对阳性结果进行基因测序分析。结果：近5年中本院儿科住院的患儿中非发酵菌感染者91例，其中新生儿35例（早产儿19例），29日龄~1岁29例，1~3岁27例；男性60例，女性31例；有基础性疾病患儿41例（45.05%），出现脏器功能损害16例（17.58%），自动出院3例（3.29%），死亡1例（1.09%）；分离非发酵菌102株，其中铜绿假单胞菌42株，鲍曼不动杆菌33株，嗜麦芽窄食单胞菌21株，其他非发酵菌6株；新生儿病区44株（43.13%），小儿重症监护病房33株（32.35%），普通儿科病区25株（24.50%）。呼吸道分泌物和血液占全部标本的84.31%；鲍曼不动杆菌和铜绿假单胞菌多重耐药（MDR）、广泛耐药（XDR）、泛耐药（PDR）分离率分别占63.63%和19.04%；铜绿假单胞菌对亚胺培南耐药率为40.48%，耐药基因检测阳性率最高的是blaPER（28.57%）；鲍曼不动杆菌对亚胺培南耐药率为36.36%，所有耐药株均携带blaOXA-51和blaOXA-23基因。结论：有基础性疾病或进行侵袭性诊治的患儿易感染非发酵菌，且多为耐药菌株，治疗困难，病程长，风险大。

关键词: 婴幼儿, 非发酵菌, 感染, 耐药性, 耐药基因

Abstract: Objective: To study the clinical characteristics, prognosis and drug resistance caused by the non-fermenting bacteria in the infants, and to provide reference for the doctors to recognize the infection features and its treatment. Methods: A total of 91 cases of non-fermentative bacteria infection were selected and the clinical materials were retrospectively analyzed. The clinical data and prognosis of the pediatric patients were analyzed, as well as the distribution and drug resistance of non-fermentative bacteria.The bacterial resistance genes were detected by PCR method, and the positive results were analyzed by gene sequencing. Results: In the past 5 years, the non-fermentative bacteria strains were isolated in 91 infant patients, including 35 cases of newborn (19 cases were premature infants), 29 cases aged less than 1 year old, 27 cases aged from 0 year to 3 years old. Among these patients, 60 were male and 31 were female. There were 41 cases with underlying diseases (45.05%), 16 cases with organ dysfunction(17.58%), 3 cases discharged automatically(3.29%),and 1 case dead(1.09%). A total of 102 strains of non-fermentative bacteria included 42 strains of Pseudomonas aeruginosa, 33 strains of Acinetobacter baumannii, 21 strains of Stenotrophomonas maltophilia and 6 strains of other non-fermentative bacteria. Forty-four strains were isolated from neonatal ward, 33 strains (32.35%) from neonatal ICU (43.13%), 25 strains (24.50%) were isolated from general pediatric ward. These strains were mainly from respiratory tract secretions and blood samples, nearly 84.31%. The isolation rates of MDR, XDR, PDR Acinetobacter baumannii and Pseudomonas aeruginosa were 63.63% and 19.04%, respectively. There were 40.48% of Pseudomonas aeruginosa isolates were resistant to imipenem, blaPER had the highest positive gene rate (28.57%).There were 36.36% of Acinetobacter baumannii isolates were resistant to imipenem, all resistant strains carried blaOXA-51 and blaOXA-23 genes. Conclusion: The infants with underlying diseases or invasive diagnosis and treatment are easy to infect non fermentative bacteria. Most strains of them are drug-resistant and difficult to be treated with long duration and high risk.

Key words: drug resistance gene, non-fermentative bacteria, infection, drug resistance, infants

中图分类号:

R446.5

周浩泉, 储新民, 戴媛媛, 代传林, 潘家华. 婴幼儿非发酵菌感染的临床特征和耐药分析[J]. 吉林大学学报(医学版), 2017, 43(05): 975-979.

ZHOU Haoquan, CHU Xinmin, DAI Yuanyuan, DAI Chuanlin, PAN Jiahua. Clinical characteristics and drug resistance analysis of non-fermentative bacteria infection in infants[J]. Journal of Jilin University Medicine Edition, 2017, 43(05): 975-979.

参考文献

[1] 王娜,贾俐萍,王莉,等.医院耐碳青霉烯类铜绿假单胞菌的流行及相关因素分析[J].中国医院药学杂志, 2016,36(2):138-140.
[2] 王涛,王瑞兰. 鲍曼不动杆菌医院感染相关危险因素及预防[J]. 中国感染与化疗杂志,2015,15(1):81-83.
[3] Magiorakos AP, Srinlivasan A,Carey RB.Multi-drug resistant,extensive drug resistantand pan-drug resistant bacteria:an international expert proposal for interim standard definitions for acquired resistance[J]. Clin Microbiol Infect, 2012,18(3):268-281.
[4] 王军,刘勇.常见非发酵菌的临床分布及耐药性分析[J].实用药物与临床,2016,19(2):235-240.
[5] 史尊基,李超,胡予丹.我院常见非发酵菌的临床变化及耐药性分析[J].中国当代医药,2014,21(24):187-198.
[6] 任伟,龙晓玲,周涛,等.儿童铜绿假单胞菌脓毒症14例临床分析[J].临床儿科杂志,2016,34(9):674-676.
[7] He S,He H,Chen Y,et al. In vitro and in vivo analysis of anti-microbial agents alone and in combination against multidrug resistant Acinetobacter baumannii[J].Front Microbiol,2015,6:507-512.
[8] Liu Q, Li W, Du X, et al. Risk and prognostic factors for multidrug-resistant Acinetobacter baumannii complex bacteremia:A retrospective study in a Tertiary Hospital of West China[J].PLoS One, 2015, 10(6):e0130701.
[9] 陈越,孙景勇,倪语星,等. 2012年中国CHINET铜绿假单胞菌耐药性监测[J].中国感染与化疗杂志,2015,15(3):199-203.
[10] Cholley P, Hocquet D, Alauzet C, et al. Hospital outbreak of Pseudomonas aeruginosa producing extended-spectrumy oxacillinase OXA-19[J]. J Med Microbiol,2010, 59(Pt7):866-869.
[11] 蒋月婷, 麦嘉玲, 陈定强,等. 耐碳青霉烯铜绿假单胞菌的耐药基因检测及分析[J]. 中国抗生素杂志,2016, 41(7):552-556.
[12] 许亚丰,耿先龙,王春新,等.多重耐药鲍曼不动杆菌β-内酰胺酶、膜孔蛋白及β-内酰胺类靶位编码基因研究[J].中国抗生素杂志,2014,39(1):58-64.
[13] 陈秀荣,王江南,朱小燕,等. ICU患者感染鲍曼不动杆菌对碳青霉烯类抗生素的耐药性及相关耐药基因分析[J]. 中国病原生物学杂志, 2015,10(8):759-762.
[14] 李永丽,陈艺升,汪雅萍,等. 重症监护病房鲍曼不动杆菌耐药性与分子流行病学研究[J]. 中国感染与化疗杂志,2015,15(6):583-587.
[15] 邓正华,温先勇,刘靳波,等. LAMP法检测耐碳青霉烯类鲍曼不动杆菌OXA-23基因的研究[J]. 国际检验医学杂志, 2015,36(4):513-515.
[16] 邓德耀,袁文丽,吴迪,等. 重症监护病房耐碳青霉烯类鲍曼不动杆菌碳青霉烯酶基因型的检测[J]. 昆明医科大学学报,2015,36(7):62-66.

婴幼儿非发酵菌感染的临床特征和耐药分析

Clinical characteristics and drug resistance analysis of non-fermentative bacteria infection in infants

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