摘要
目的探讨儿童恶性肿瘤化疗后并发败血症的诊断和治疗,指导经验性用药。方法对化疗后发热的病儿做血培养,建立病原菌谱和药敏数据库,分析近5年的监测资料。结果在104次败血症中分离到106株病原菌,包括64株(63.8%)革兰氏阴性(G-)杆菌,其中肺炎克雷伯氏菌17株、铜绿假单胞菌15株、大肠埃希氏菌14株;另外培养出革兰氏阳性(G+)细菌36株、真菌6株。发生感染性休克11例次,10次为G-杆菌引起,以肺炎克雷伯氏菌及大肠埃希氏菌发生率高。与G+细菌不同,G-杆菌败血症多数(68.8%)伴畏寒、寒战。G+细菌全部对万古霉素和替考拉宁敏感,利福平联合环丙沙星、庆大霉素的敏感率分别为92.3%和90.9%。9株凝固酶阴性葡萄球菌中耐甲氧西林5株(55.6%)。G-杆菌绝大多数对亚胺培南、美罗培南敏感(98.4%、97.7%),其次为头孢比肟(88.2%)、头孢哌酮/舒巴坦(88.1%)、哌拉西林/他唑巴坦(88.1%),头孢他定、阿米卡星与环丙沙星三者中任何两种联合对全部G杆菌的敏感率均在90%以上,后二者与哌拉西林/他唑巴坦联用则各达95%以上。产ESBLs的肺炎克雷伯氏菌、大肠埃希氏菌分别有7株(41.2%)和4株(28.6%);大肠埃希氏菌耐环丙沙星7株(50%)。结论本组病儿化疗后败血症病原菌以G-杆菌为主,最常见为肺炎克雷伯氏菌、大肠埃希氏菌及铜绿假单胞菌,前二者易引致感染性休克。G+球菌对万古霉素、替考拉宁敏感;G-杆菌以亚胺培南、美罗培南敏感率最高;一些常用、经济的抗菌药联用可明显提高菌谱覆盖范围。
Objective To study the incidence and antibiotic susceptibility of different pathogens attributed to the bacteremia in pediatric oncologic patients so as to guide the anti -microbe drugs choosing. Methods Blood samples for microbiological culturing were got from each febrile inpatient after chemotherapy and positive results for the past 5 years were analyzed. Results Of 106 organisms isolated from 104 bacteremias, 63.8% were G^- bacilli. Klebsiella pneumoniae （17）, Pseudomonas aeruginosa （15）and Escherichia coli （14） were isolated most often. A total of l0 septic shock occurred, in which 9 were caused by G- bacilli, most often in Klebsiella pneumoniae and Escherichia coli. Chills were presented in most of patients with gram - negative bacilli. All of the G^＋ bacteria isolated were susceptible to vancomycin and teicoplanin, 92.3% susceptible to rifampin when combined with ciprofloxacin. Most of the G^- bacilli were susceptible to imipenem （98.4%）, meropenem （97. 7% ）, cefopime （88. 2% ）, piperacillin/tazobactam （ 88.1% ） and cefoperazone/sulbactam （88.1% ）. More than 90% of all of the gram - negative bacilli were susceptible to the combination of any two of the following antibiotics： piperacillin/tazobactam, cefotazidine, ciproiloxacin and amikacin. Seven （41.2%） of the Klebsiella pneumoniae and 4 （28.6%） of the Escherichia coil produced ESBLs. Seven （50%） of the Escherichia coli resistant to ciprofloxacin.Conclusion Gram- negative bacilli are the most often isolates in bacteremias after chemotherapy. Septic shock occurs more often in Klebsiella pneumoniae or Escherichia coli bacteremia. All of the G^＋ isolates were susceptible to vancomycin and teicoplanin, most of the G^- isolates susceptible to imipenem and meropenem. Combinations of some common antibiotics significantly increased the susceptibility.
出处
《中国小儿血液与肿瘤杂志》
CAS
2006年第2期62-65,共4页
Journal of China Pediatric Blood and Cancer
