摘要
目的比较入住重症监护室(ICU)的儿童与成人患者血流感染(BSI)病原菌分布、耐药性、临床特点。方法回顾性分析ICU收治的BSI患儿96例(儿童组)和成人患者331例(成人组),比较两组病原菌分布、耐药性及临床症状和主要实验室指标。结果儿童组血培养标本共分离阳性菌株96株(5.1%),其中革兰阳性菌65株、革兰阴性菌30株、真菌1株;成人组血培养标本共分离阳性菌株331株(9.3%),其中革兰阳性菌106株、革兰阴性菌202株、真菌23株。成人组分离的凝固酶阴性葡萄球菌、金黄色葡萄球菌对喹诺酮类抗生素耐药率分别为30.3%、29.0%显著高于儿童组(8.6%、0);两组分离的肺炎克雷伯菌对碳青霉烯类抗生素的耐药性均显著高于大肠埃希菌,肺炎克雷伯菌耐药形势严峻。儿童组基础疾病以重症肺炎、血液肿瘤疾病、先天性心脏病为主,成人组以重症肺炎、中枢神经系统感染及严重外伤为主;儿童组的血清降钙素原水平与外周血白细胞计数分别为(11.96±23.01)ng/mL、(22.77±13.56)×10^(9)/L,成人组分别为(17.34±32.38)ng/mL、(16.06±7.79)×10^(9)/L,两组比较,存在显著差异;两组高敏感C反应蛋白与白细胞介素6水平在BSI早期均迅速上升。结论ICU BSI儿童分离的病原菌以革兰阳性菌为主,对绝大多数抗生素敏感;成人分离的病原菌以革兰阴性菌为主,对喹诺酮类抗生素耐药率高于儿童。儿童和成人BSI者都有严重的基础疾病、免疫功能低下,临床上应对血培养阳性患者持续监测,并合理使用抗生素。
Objective To compare the distribution,drug resistance and clinical characteristics of pathogenic bacteria in children and adults with bloodstream infection(BSI)admitted to intensive care unit(ICU).Methods Retrospective analysis was performed on 96 children(child group)and 331 adults(adult group)with BSI admitted to ICU.The pathogen distribution,drug resistance,clinical symptoms and main laboratory indicators of the two groups were compared.Results A total of 96 positive strains(5.1%)were isolated from blood culture samples of the child group,including 65 Gram-positive strains,30 Gram-negative strains and 1 fungus strain.A total of 331 positive strains(9.3%)were isolated from blood culture samples of the adult group,including 106 strains of Gram-positive bacteria,202 strains of Gram-negative bacteria and 23 strains of fungi.The resistance rates of coagulase negative Staphylococcus(CNS)and Staphylococcus aureus isolated from the adult group to quinolone antibiotics were 30.3%and 29.0%,respectively,which were significantly higher than those of the child group(8.6%,0);the resistance of Klebsiella pneumoniae isolated from the two groups to carbapenems antibiotics was significantly higher than that of Escherichia coli,and the resistance of Klebsiella pneumoniae made the use of antibiotics difficult.The basic diseases in the child group were mainly severe pneumonia,hematologic tumor disease and congenital heart disease,while those in the adult group were mainly severe pneumonia,central nervous system infection and severe trauma.The levels of procalcitonin(PCT)in serum and white blood cell count(WBC)in peripheral blood of the children were(11.96±23.01)ng/mL and(22.77±13.56)×10^(9)/L,respectively,and the levels of PCT in serum and WBC count in peripheral blood of adults were(17.34±32.38)ng/mL and(16.06±7.79)×10^(9)/L,respectively.There were significant differences between the two groups.The high-sensitivity C-reactive protein(CRP)and interleukin 6(IL-6)increased rapidly in the early stage of bloodstream infection in both groups.Conclusions The pathogenic bacteria isolated from children with BSI in ICU are mainly Gram-positive bacteria,which are sensitive to most antibiotics.The pathogenic bacteria isolated from adults are mainly Gram-negative bacteria,and the resistance rate to quinolone antibiotics is higher in adults than in children.Both children and adults with BSI have serious basic diseases and low immune function.Patients with positive blood culture should be monitored continuously and antibiotics should be used rationally during clinical treatment.
作者
张燕
周晋
曹彤
李喆倩
ZHANG Yan;ZHOU Jin;CAO Tong;LI Zheqian(Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School,Nanjing 210000,China;不详)
出处
《山东医药》
CAS
2021年第12期19-22,共4页
Shandong Medical Journal
基金
南京医科大学科技发展基金项目(NMUB2019209)。
关键词
儿童
成人
血流感染
重症监护室
children
adults
bloodstream infection
intensive care unit
