Megged Orli, Schlesinger Yechiel, Attias Denise, Rudensky Bernard
Pediatric Department and Infectious Diseases Unit, Shaare Zedek Medical Center, Jerusalem.
Harefuah. 2009 Nov;148(11):766-8, 793.
Pseudomonas aeruginosa carriage in the gastrointestinal tract is uncommon in healthy children. Children living in chronic care institutions are often carriers of P. aeruginosa in the respiratory tract, but data is lacking regarding gastrointestinal carriage in these children.
To examine the carriage rate of P. aeruginosa in children living in chronic care institutions in Jerusalem and to assess resistance rates of the bacteria to different classes of antibiotics.
Rectal swabs were taken from all children residing in two chronic care institutions in Jerusalem: "St. Vincent" and "Aleh". The swabs were examined for presence of Pseudomonas aeruginosa. The authors used disk diffusion technique and E Test to assess resistance for different antibiotics.
Gastrointestinal carriage of P. aeruginosa was detected in 37 out of 125 of the children (30%); 16% of the P. aeruginosa isolates were resistant to carbapenems; 16% were resistant to aminoglycosides, 14% to ureidopenicillins and 11% to quinolones. All isolates were sensitive to ceftazidime and colistin. In 84% of the isolates, the minimal inhibitory concentration (MIC) for meropenem was significantly lower than the MIC for imipenem.
P. aeruginosa is a common colonizer of the gastrointestinal tract of children living in chronic care institutions. Empiric antibiotic treatment against P. aeruginosa should be considered when treating children with acute gastrointestinal pathologies. Antibiotic resistance, and particularly carbapenem resistance, is common in this population. There is a significant difference between the MICs for imipenem and meropenem. Future studies are needed to understand the clinical significance of this finding.
在健康儿童中,胃肠道携带铜绿假单胞菌的情况并不常见。生活在长期护理机构的儿童通常是呼吸道铜绿假单胞菌的携带者,但缺乏关于这些儿童胃肠道携带情况的数据。
研究耶路撒冷长期护理机构中儿童铜绿假单胞菌的携带率,并评估该细菌对不同类抗生素的耐药率。
从耶路撒冷两家长期护理机构“圣文森特”和“阿莱”的所有儿童中采集直肠拭子。检测拭子中是否存在铜绿假单胞菌。作者使用纸片扩散法和E试验评估对不同抗生素的耐药性。
125名儿童中有37名(30%)检测到胃肠道携带铜绿假单胞菌;16%的铜绿假单胞菌分离株对碳青霉烯类耐药;16%对氨基糖苷类耐药,14%对脲基青霉素耐药,11%对喹诺酮类耐药。所有分离株对头孢他啶和多粘菌素敏感。在84%的分离株中,美罗培南的最低抑菌浓度(MIC)显著低于亚胺培南的MIC。
铜绿假单胞菌是生活在长期护理机构儿童胃肠道的常见定植菌。在治疗患有急性胃肠道疾病的儿童时,应考虑针对铜绿假单胞菌进行经验性抗生素治疗。该人群中抗生素耐药,尤其是碳青霉烯类耐药很常见。亚胺培南和美罗培南的MIC之间存在显著差异。需要进一步研究以了解这一发现的临床意义。