[汶川地震后儿童感染伤口分离病原菌的分布及耐药性]

Ran Ying-chun, Ao Xiao-xiao, Liu Lan, Fu Yi-long, Tuo Hui, Xu Feng

Pediatric Intensive Care Unit and Department of Laboratory Medicine, Children's Hospital, Chongqing Medical University, Chongqing 400014, China.

Zhonghua Er Ke Za Zhi. 2009 May;47(5):332-6; discussion 336-7.

OBJECTIVE

To investigate the distribution and the drug resistance pattern of pathogenic bacteria isolated from pediatric cases suffering from wounds infection following the Wenchuan earthquake.

METHODS

Of the ninety-eight injured children, 50 had wound infection diagnosed by clinical examination. Specimens for culture were collected from the fifty injured children and the results of bacterial identification and antibiotic resistance were retrospectively reviewed.

RESULTS

In the fifty injured children with wound infection, microbial growth was detected in 31 (62.0%) and 21 children suffered from mixed infections (the infection rate was 67.7%). Ninety-nine pathogens were isolated, gram positive bacteria accounted for 16.16% (16 strains), Gram negative bacteria accounted for 81.82% (81 strains), and fungus 2.02% (2 strains). Staphylococcus aureus (5 strains, 5.05%), Enterococcus faecalis (3 strains, 3.03%) and Enterococcus faecium (2 strains, 2.02%) were the primary Gram-positive bacteria identified and Gram-negative infections typically included Acinetobacter baumanii (27 strains, 27.27%), Enterobacter cloacae (18 strains, 18.18%) and Pseudomonas aeruginosa (13 strains, 13.13%). Acinetobacter baumanii was the most common organism isolated from wounds. Duration of being szeged and complications had a significant association with wound infection with Acinetobacter baumanii. Drug sensitivity tests displayed that the isolated bacteria were highly resistant to common antibiotics. One strain of Acinetobacter baumanii-calcoaceticus complex and six strains of Acinetobacter baumanii were resistant to all common antibiotics including imipenem/cilastatin. Vancomycin-resistant Gram-positive bacteria were not identified.

CONCLUSION

Following the Wenchuan earthquake disaster, wound infection profiles of pediatric patients were significantly different, Acinetobacter baumanii was the main common organism isolated from wounds in contrast to the previous low isolation rate. The isolated bacteria were highly and multiple drug resistant and it was difficult to treat. Knowing the distribution and the drug resistance pattern of pathogen is of paramount importance in guiding the clinical treatment.

目的

调查汶川地震后小儿创伤感染分离病原菌的分布及耐药情况。

方法

98例受伤儿童中，50例经临床检查诊断为创伤感染。收集这50例受伤儿童的培养标本，回顾性分析细菌鉴定及药敏结果。

结果

50例创伤感染患儿中，31例（62.0%）检出微生物生长，21例为混合感染（感染率为67.7%）。共分离出99株病原菌，革兰阳性菌占16.16%（16株），革兰阴性菌占81.82%（81株），真菌占2.02%（2株）。主要革兰阳性菌为金黄色葡萄球菌（5株，5.05%）、粪肠球菌（3株，3.03%）和屎肠球菌（2株，2.02%），革兰阴性菌感染主要包括鲍曼不动杆菌（27株，27.27%）、阴沟肠杆菌（18株，18.18%）和铜绿假单胞菌（13株，13.13%）。鲍曼不动杆菌是创伤分离最常见的病原菌。住院时间及并发症与鲍曼不动杆菌创伤感染显著相关。药敏试验显示，分离菌对常用抗生素高度耐药。1株鲍曼不动杆菌-醋酸钙复合菌和6株鲍曼不动杆菌对包括亚胺培南/西司他丁在内的所有常用抗生素耐药。未检出耐万古霉素革兰阳性菌。