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

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。

Abstract:

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 171 patients，including 74 Gram-positive （G⁺） and 8 Gram-negative strains（G^-）. The top three bacteria were Staphylococcus aureus（54 strains，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 appropriate 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.