儿童金黄色葡萄球菌肺炎的临床特点及耐药性分析

发布时间：2018-06-08 17:23

本文选题：金黄色葡萄球菌肺炎 + 耐药性　；参考：《重庆医科大学》2014年硕士论文

【摘要】：目的：分析金黄色葡萄球菌肺炎(staphylococcus aureuspneumonia，SAP)的临床特点及金黄色葡萄球菌(staphylococcus aureus，SA)的耐药性，为临床诊断和合理用药提供依据。方法：回顾性分析44例重庆医科大学儿童医院2008年9月~2013年12月确诊为金黄色葡萄球菌肺炎的临床特点及其药敏结果。结果：（1）SAP患儿男女比为2.67:1，以3岁以下婴幼儿和6岁以上学龄期儿童居多。SAP比一般细菌性肺炎病情重、进展快、病情变化快，其典型症状包括长时间持续或反复高热、严重感染中毒症状重及感染性休克。30（68.2%）例SAP患儿实验室检查有白细胞升高，，36例（81.8%）患儿中性比例升高。42例进行C反应蛋白检查，其中33例（78.6%）增高。21例患儿进行了降钙素原检查，均增高。39例（88.6%）患儿出现并发症，SAP易致多器官感染和多脏器功能损害。（2）44株SA对氨苄青霉素（100%vs96.2%）、阿莫西林/棒酸（42.5%vs3.8%）、庆大霉素（19.0%vs3.8%）、环丙沙星（9.3%vs0%）、利福平（7.3%vs0%）的耐药率明显高于我院1993-2003年SA的耐药率。44株SA中甲氧西林敏感金黄色葡萄球菌菌株（methicillin-sensitiveStaphy1ococcus aureus，MSSA）29例（65.9%），甲氧西林耐药金黄色葡萄球菌菌株（methicillin-resistant Staphy1ococcus aureus，MRSA）15例（34.1%）。SA对青霉素、氨苄青霉素、红霉素、克林霉素、头孢西丁、阿莫西林/棒酸、苯唑西林的耐药率分别为100%、100%、74.4%、73.8%、58.6%、42.5%、39.0%，对四环素、甲氧苄氮嘧啶、复方新诺明、妥布霉素、庆大霉素、莫匹罗星、阿米卡星、环丙沙星、利福平、莫匹罗星-HL、呋喃妥因耐药率较低，分别为29.3%、28.6%、26.2%、23.8%、19.0%、18.2%、9.5%、9.3%、7.3%、4.7%、2.4%，尚未发现对万古霉素、替考拉林、利奈唑胺、奎鲁普丁/达福普丁、夫西地酸耐药的SA菌株。MRSA对苯唑西林、头孢西丁、红霉素、克林霉素、利福平、阿莫西林/棒酸的耐药率显著高于MSSA，差异具有统计学意义（P0.05）。结论：重庆地区SAP好发于3岁以下婴幼儿和6岁以上学龄期儿童，SAP比一般细菌性肺炎病情重、进展快、变化快，容易出现多器官组织并发症，加强金黄色葡萄球菌的耐药监测对指导临床用药有重要意义。重庆地区SA对多种抗生素的耐药率呈增加趋势，SA对β-内酰胺类抗生素耐药率高，MRSA对多种抗生素的耐药性显著高于MSSA。
[Abstract]:Objective: to analyze the clinical characteristics of Staphylococcus aureus pneumoniae (SAP) and the drug resistance of Staphylococcus aureus SAP. Methods: 44 cases of Staphylococcus aureus pneumonia diagnosed in Children's Hospital of Chongqing Medical University from September 2008 to December 2013 were analyzed retrospectively. The ratio of male to female was 2.67: 1. The majority of children under 3 years old and 6 years old were children of school age. SAP was more serious than general bacterial pneumonia. Rapid progression, rapid changes in the condition, its typical symptoms include prolonged or repeated high fever, Severe infection and severe septic shock (68.2%). Laboratory examination of 36 cases with elevated leukocyte count in 36 cases with elevated leukocyte in 36 cases (81.8%). Among them 33 cases (78.6%) were examined for C-reactive protein, and 21 cases were examined for procalcitonin (P < 0.05). All of the 39 children with complications of SAP were prone to multiple organ infection and multiple organ function damage. The resistant rate of SA to ampicillin 100 vs 96. 2 was significantly higher than that of rifampicin on ampicillin 100 vs 96. 2, amoxicillin / piperonium 42.5 vs 3. 8, gentamicin 19.0 vs 3. 8, ciprofloxacin 9.3vs0 and rifampicin 7.3vs0. The drug resistance rate of methicillin-sensitive Staphylococcus aureus strains from 1993 to 2003 was 44 strains of SA. 29 cases of methicillin-sensitive Staphy1ococcus aureus and 15 cases of methicillin-resistant Staphy1ococcus aureus MRSAA were treated with penicillin, and 15 cases with methicillin-resistant Staphy1ococcus aureus MRSAA were treated with methicillin-resistant Staphy1ococcus aureus MRSA.Methicillin-resistant Staphylococcus aureus MRSA15 cases were treated with methicillin-sensitive Staphy1ococcus aureus. The drug resistance rates of ampicillin, erythromycin, clindamycin, cefoxitin, amoxicillin / rhodoxicillin, oxacillin and oxacillin were 100 / 100 and 74.4 / 74.4respectively, and 73.8 / 58.6and 42.5cm, respectively, to tetracycline, trimethoprim, compound sulfamethoxine, tobramycin, gentamycin, mopiroxacin, ampicillin, trimethoprim, tobramycin, gentamycin, mopiroxine, and ampicillin. The drug resistance rates of amikacin, ciprofloxacin, rifampicin, mupiroxin--HL, furantoin were lower, 29.30.28.6c26.2 and 19.823.823.818.2cm, respectively, and 9.59.3c7.3cm = 4.72.4.The resistance to vancomycin, tecorarin, linazolamine, quinapudine / daputin was not found. Oxacillin, cefoxitin, erythromycin, clindamycin, rifampicin, rifampicin, The drug resistance rate of amoxicillin / knotonic acid was significantly higher than that of MSSA.The difference was statistically significant (P 0.05). Conclusion: SAP in Chongqing area is more severe, faster and faster than that of general bacterial pneumonia in infants under 3 years old and children aged 6 years in school. Multiple organ and tissue complications are easy to occur. It is important to strengthen the drug resistance monitoring of Staphylococcus aureus. The resistance rate of SA to multiple antibiotics in Chongqing area showed an increasing trend. The resistance rate of SA to 尾 -lactam antibiotics was higher than that of MRSA to multiple antibiotics.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R725.6

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