儿童侵袭性鲍曼不动杆菌感染的临床特征和耐药分析

刘琳; 董琳; 徐月波; 陈兆兴; 樊节敏

doi:10.7499/j.issn.1008-8830.2013.05.015

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中国当代儿科杂志 ›› 2013, Vol. 15 ›› Issue (5) : 379-382. DOI: 10.7499/j.issn.1008-8830.2013.05.015

论著·临床研究

儿童侵袭性鲍曼不动杆菌感染的临床特征和耐药分析

刘琳，董琳，徐月波，陈兆兴，樊节敏

作者信息 +

Clinical characteristics and antibiotic resistance in children with invasive Acinetobacter baumannii infection

LIU Lin, DONG Lin, XU Yue-Bo, CHEN Zhao-Xing, FAN Jie-Min

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摘要

目的：分析儿童侵袭性鲍曼不动杆菌感染（invasive Acinetobacter Baumannii infection，IABI）的临床和耐药特征。方法：回顾性分析2004年1月至2011年12月52例IABI患儿的临床和细菌药敏资料。结果：52例IABI患儿中1岁以下患儿占67%，发病以夏秋季为主（67%）。临床诊断败血症19例（37%）,尿路感染16例（31%），皮肤软组织感染12例（23%）。伴有基础疾病38例(73%)。医院获得和社区获得性感染分别占90%和10%。临床治愈及好转44例（85%），死亡8例（15%）。所有菌株对阿米卡星完全敏感，对亚胺培南的敏感率达82%，对氟喹诺酮类抗生素、头孢哌酮/舒巴坦的敏感率均超过70%，对头孢哌酮和氨曲南的敏感率仅为13%和8%，多重耐药率及泛耐药率分别为21%和17%。结论：儿童IABI好发于1岁以下，多数存在基础疾病；主要导致败血症、尿路感染和皮肤软组织感染，以医院获得性感染为主；IAB菌株的多重耐药和泛耐药现象已较严重。

Abstract

OBJECTIVE: To analyze the clinical characteristics and antibiotic resistance in children with invasive Acinetobacter baumannii infection (IABI). METHODS: A retrospective analysis was performed on the clinical and drug sensitivity data of 52 children with IABI between January 2004 and December 2011. RESULTS: Of the 52 children with IABI, 35 (67%) were less than one year old and 35 (67%) had IABI in the summer and autumn, 19 (37%) of these children were clinically diagnosed with septicemia, 16 (31%) with urinary tract infection, and 12 (23%) with skin and soft tissue infection, and 38 (73%) of them suffered from underlying diseases. The incidence rates of hospital-acquired and community-acquired IABIs were 90% and 10% respectively; 44 cases (85%) were cured or showed improvement in symptoms, and 8 cases (15%) died. All the IAB strains isolated from these children were sensitive to amikacin, 82% of them were sensitive to imipenem, more than 70% were sensitive to fluoroquinolone and to cefoperazone/sulbactam, 13% were sensitive to cefoperazone, 8% were sensitive to aztreonam, 21% developed multidrug resistance, and 17% developed pan-drug resistance. CONCLUSIONS: IABI occurs more frequently in children under one year of age, and most children with IABI have underlying diseases. IABI mainly results in septicemia, urinary tract infection and skin and soft tissue infection and is mostly hospital-acquired. Multi-drug resistance and pan-drug resistance are severe in IAB strains.

导出引用

刘琳，董琳，徐月波，陈兆兴，樊节敏. 儿童侵袭性鲍曼不动杆菌感染的临床特征和耐药分析[J]. 中国当代儿科杂志. 2013, 15(5): 379-382 https://doi.org/10.7499/j.issn.1008-8830.2013.05.015

LIU Lin, DONG Lin, XU Yue-Bo, CHEN Zhao-Xing, FAN Jie-Min. Clinical characteristics and antibiotic resistance in children with invasive Acinetobacter baumannii infection[J]. Chinese Journal of Contemporary Pediatrics. 2013, 15(5): 379-382 https://doi.org/10.7499/j.issn.1008-8830.2013.05.015

参考文献

［1］Maragakis LL, Perl TM. Acinetobacter baumannii: epidemiology, antimicrobial resistance, and treatment options［J］. Clin Infect Dis, 2008, 46(8): 1254-1263.

［2］Loivukene K, Kermes K, Sepp E, Adamson V, Mitt P, Jurna M, et al. The comparison of susceptibility patterns of Gramnegative invasive and non-invasive pathogens in Estonian hospitals［J］. Antonie Van Leeuwenhoek, 2006, 89(3-4): 367-371.

［3］Falagas ME, Karveli EA, Kelesidis I, Kelesidis T. Community-acquired Acinetobacter infections［J］. Eur J Clin Microbiol Infect Dis, 2007, 26(12): 857-868.

［4］朱德妹, 汪复, 胡付品, 蒋晓飞, 倪语星, 孙景勇, 等. 2010年中国CHINET细菌耐药性监测［J］. 中国感染与化疗杂志, 2011,11(5):321-329.

［5］Simmonds A, Munoz J, Aguero-Rosenfeld M, Carbonaro C, Montecalvo M, Clones B, et al. Outbreak of Acinetobacter infection in extremely low birth weight neonates［J］. Pediatr Infect Dis J, 2009, 28(3): 210-214.

［6］Punpanich W, Nithitamsakun N, Treeratweeraphong V, Suntarattiwong P. Risk factors for carbapenem non-susceptibility and mortality in Acinetobacter baumannii bacteremia in children［J］. Int J Infect Dis, 2012, 16(11): e811-e815.

［7］陈佰义, 何礼贤, 胡必杰, 倪语星, 邱海波, 石岩, 等. 中国鲍曼不动杆菌感染诊治与防控专家共识［J］. 中华医学杂志, 2012,92(2):76-85.

［8］Saleem AF, Shah MS, Shaikh AS, Mir F, Zaidi AK. Acinetobacter species meningitis in children: a case series from Karachi, Pakistan［J］. J Infect Dev Ctries, 2011, 5(11): 809-814.

［9］Sebeny PJ, Riddle MS, Petersen K. Acinetobacter baumannii skin and soft-tissue infection associated with war trauma［J］. Clin Infect Dis, 2008, 47(4): 444-449.

［10］Ran YC, Ao XX, Liu L, Fu YL, Tuo H, Xu F. Microbiological study of pathogenic bacteria isolated from paediatric wound infections following the 2008 Wenchuan earthquake［J］. Scand J Infect Dis, 2010, 42(5): 347-350.

［11］Chang PY, Hsueh PR, Wu PS, Chan PC, Yang TT, Lu CY, et al. Multidrug-resistant Acinetobacter baumannii isolates in pediatric patients of a university hospital in Taiwan［J］. J Microbiol Immunol Infect, 2007, 40(5): 406-410.

［12］马序竹, 吕媛, 薛峰. 2010年度卫生部全国细菌耐药监测报告:血流感染细菌耐药监测［J］. 中华医院感染学杂志, 2011,21(24):5147-5151.

［13］Fishbain J, Peleg AY. Treatment of Acinetobacter infections［J］. Clin Infect Dis, 2010, 51(1): 79-84.

［14］Tuon FF, Penteado-Filho SR, Amarante D, Andrade MA, Borba LA. Mortality rate in patients with nosocomial Acinetobacter meningitis from a Brazilian hospital［J］. Braz J Infect Dis, 2010, 14(5): 437-440.

［15］金志鹏, 成怡冰, 王群思, 王琪, 葛燕军. 儿科重症监护病房鲍曼不动杆菌感染临床及耐药性分析［J］. 中国当代儿科杂志, 2012,14(3):229-230.