儿童急性骨关节感染病原菌分析及治疗研究

发布时间：2018-03-02 10:17

本文关键词： 儿童骨关节感染细菌培养药敏实验手术治疗耐药菌　出处：《安徽医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:通过对当前儿童急性骨关节感染病原菌的种类及耐药性的总结分析,结合临床治疗的经验体会,探讨其合理有效的治疗方法。方法:选择自2011年1月至2015年03月在我科收治的急性骨关节感染患儿223例,其中骨髓炎71例,化脓性关节炎95例,骨髓炎合并化脓性关节炎20例,合并败血症等全身感染32例,合并多部位感染5例。年龄跨度在14天-14岁(平均5.4岁),就诊时病程时间2-13天(平均5.6天),根据在院期间病原菌培养结果及药敏试验资料,结合在院期间诊治经过,治疗方式的选择,抗生素的使用情况,以及后期半年内随诊预后情况进行分类比较和统计。结果:223例患儿共117例细菌培养阳性(52.5%),总共培养出革兰阳性(G+)球菌93株,革兰阴性(G㧟)杆菌30株,前三位分别为金黄色葡萄球菌85例(69%)、铜绿假单孢菌7例(5.7%)、大肠埃希菌5例(4.1%),无真菌及结核杆菌等特殊菌株,血脓培养均阳性6例,病原菌种类一致4例,耐药菌株共38例,耐药菌株比例为36.6%。各年龄段患儿耐药菌比例相近。223例患儿全部入院即行抗感染治疗。单纯抗感染保守治疗13例,合并手术治疗210例,二次及以上手术6例,术后持续冲洗引流206例,其中抗生素持续冲洗引流90例,静脉抗生素治疗时间10-42天(平均16天),入院时病程1周以内患儿198例,入院时病程7-13天患儿25例。半年内随访总优良率88.8%,预后差病例包括后遗骨关节功能障碍12例,骨骺板损伤造成远期肢体生长障碍6例,病理性脱位3例,大段骨坏死吸收2例,死亡2例。结论:金黄色葡萄球菌仍为儿童急性骨关节感染的主要致病菌,主要致病菌种类与国内相关成人骨髓炎文献报道大致相符,革兰阴性杆菌(G-)感染无明显上升,革兰氏阴性杆菌感染多合并全身感染,血培养阳性者较多。多重耐药菌比例明显增多,合并全身严重感染病例增多,多重耐药菌感染与患儿年龄段无关,与病程时间及感染严重程度相关。抗生素治疗应及时足量足程,培养阴性或结果未出前,需双联抗感染,抗生素选择需兼顾常见G-、G+菌,后期据药敏及时调整用药,耐药菌的增多需增大强效抗生素的应用。手术指征明确者及时切开引流,术后局部灌洗,病程在1周内的儿童急性骨关节感染治疗效果明显优于1周以后,优良率高。选择合理有效的治疗方式,最大程度的缩短病程时间,是儿童骨关节感染治疗的关键。
[Abstract]:Objective: to summarize and analyze the types and drug resistance of pathogenic bacteria of acute osteoarthrosis infection in children at present, combined with the experience of clinical treatment. Methods: from January 2011 to March 2015, we selected 223 children with acute osteoarthritis, including 71 cases of osteomyelitis, 95 cases of suppurative arthritis, 20 cases of osteomyelitis combined with suppurative arthritis. 32 cases were complicated with septicemia and 5 cases with multiple site infection. The age ranged from 14 days to 14 years old (mean 5.4 years old), and the course of disease was 2-13 days (average 5.6 days). Combined with the course of diagnosis and treatment, the choice of treatment methods, and the use of antibiotics during the hospital period, Results 117 cases of bacterial culture positive and 52.5% positive bacteria were cultured in a total of 93 strains of Gram-positive G) cocci and Gram-negative G? ) of the 30 strains, the first three were Staphylococcus aureus in 85 cases, Pseudomonas aeruginosa in 7 cases, Pseudomonas aeruginosa in 7 cases, Escherichia coli in 5 cases, Escherichia coli in 5 cases, special strains such as fungi and Mycobacterium tuberculosis in 6 cases, positive in blood pus culture in 6 cases, and pathogenic bacteria in 4 cases. There were 38 drug-resistant strains, and the proportion of drug-resistant strains was 36.6. The rate of drug-resistant bacteria was similar in every age group. All 223 cases were treated with anti-infective therapy immediately after admission. There were 13 cases of simple conservative anti-infection treatment, 210 cases of combined surgical treatment and 6 cases of secondary or above operation. There were 206 cases of continuous irrigation and drainage after operation, 90 cases of which were treated with antibiotics. The duration of intravenous antibiotic therapy was 10-42 days (mean 16 days). 198 cases were treated with antibiotics within 1 week after admission. The total excellent and good rate of half a year follow-up was 88. 8%. The poor prognosis included 12 cases of residual bone and joint dysfunction, 6 cases of long term limb growth disorder caused by epiphyseal plate injury, 3 cases of pathological dislocation, 2 cases of large bone necrosis and absorption, 6 cases of long term limb growth disorder caused by epiphyseal plate injury, 3 cases of pathological dislocation, 2 cases of large segment osteonecrosis and absorption. Conclusion: Staphylococcus aureus is still the main pathogen of acute osteoarticular infection in children. The infection of Gram-negative bacilli was associated with systemic infection, and the positive cases of blood culture were more. The proportion of multidrug resistant bacteria increased obviously, and the cases of serious systemic infection increased, and the infection of multidrug resistant bacteria was not related to the age of the children. Antibiotic treatment should be sufficient in time, negative culture or before the result of the results, need to double anti-infection, antibiotic selection should take account of common G-G bacteria, according to the drug sensitivity timely adjustment of drug use. The use of strong antibiotics should be increased with the increase of drug-resistant bacteria. The patients with definite surgical indications should be cut and draining in time, local lavage after operation, and the treatment effect of acute osteoarticular infection in children with the course of disease within 1 week was obviously better than that after 1 week. The choice of reasonable and effective treatment methods to shorten the duration of disease to the greatest extent is the key to the treatment of children with osteoarthritis infection.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R726.8

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