摘要目的 总结遵义医学院附属医院近9年儿童骨关节化脓性感染致病菌的类型及耐药情况,为临床合理使用抗生素提供参考.方法 回顾性分析遵义医学院附属医院2008年1月至2016年10月收治的102例血源性骨关节化脓性感染患儿的临床资料,男57例,女45例;年龄10 d～14岁,平均5.5岁.其中急性骨髓炎38例,化脓关节炎30例,慢性骨髓炎27例,同时患有血源性骨髓炎伴化脓性关节炎7例.对其血培养、脓液培养结果及药物敏感试验结果进行分析总结.结果 102例患儿血培养或脓液培养结果提示均为单菌种感染,金黄色葡萄球菌(SA)89例(87.30％),化脓性链球菌3例(2.94％),肺炎克雷伯菌、溶血性葡萄球菌各2例(1.96％),肺炎链球菌、缓症链球菌、表皮葡萄球菌、海氏肠球菌、阴沟肠杆菌及铜绿假单胞菌各1例(0.98％).SA对青霉素耐药率达92.1％,对林可霉素、红霉素、头孢西丁及四环素耐药率超过50.0％,对磺胺甲噁唑、庆大霉素和利福平的耐药性较低,未发现对利奈唑胺、奎奴普丁/达福普丁、莫西沙星、替加环素、万古霉素、左氧氟沙星、呋喃西林耐药菌株.除耐甲氧西林金黄色葡萄球菌(MRSA) 45例和耐甲氧西林表皮葡萄球菌1例外,其他未见多重耐药菌株.结论 本地区儿童血源性骨关节感染致病菌以SA为主,在SA所致的儿童血源性骨关节感染病例中,对青霉素的耐药率和MRSA检出率均较高,未见对万古霉素耐药菌株.

abstractsObjective To summarize the bacterial types and drug resistance of children with bone and joint purulent infection in the Affiliated Hospital of Zunyi Medical College in recent 9 years,so as to provide reference for rational use of antibiotics in clinics.Methods A retrospective study was performed on the clinical data of 102 children with hematogenous bone and joint purulent infection in the Affiliated Hospital of Zunyi Medical College from January 2008 to October 2016,in which there were 57 boys and 45 girls with a mean age 5.5 years old(from 10 days to 14 years old),among which 38 cases were acute osteomyelitis,30 cases were pyogenic arthritis,27 cases were chronic osteomyelitis,and 7 cases were arthritis with hematogenous osteomyelitis.The results of blood culture,pus culture and antibiotic sensitivity test results were analyzed and summarized.Results The results of blood culture or pus culture in 102 cases were all infected by single bacteria,including 89 cases of staphylococcus aureus(SA),accounting for 87.30％,3 cases (2.94％) of micrococcus scarlatinae,2 cases (1.96％) of klebsiella pneumoniae,2 cases (1.96％) of staphylococcus haemolyticus,and 1 case (0.98％) of methicillin-resistant staphylococcus epidermidis,streptococcus pneumoniae,streptococcus mitis,enterococcus hirae,enterobacter cloacae and pseudomonas aeruginosa,respectively.The resistance rate of SA to penicillin was 92.1％,but to Lincomycin,Erythromycin,Cefoxitin and Tetracycline it was more than 50.0％,and to Sulfamethoxazole,Gentamicin and Rifampicin it was quite low,and the resistant strains to Linezolid,Quinupristin/Dafoe Putin,Mo Xisha star,Tigecycline,Vancomycin,Levofloxacin,Nitrofurazone were no found.There were not multi drug resistant strains to be found except in the 45 cases of methicillin-resistant staphylococcus aureus(MRSA) and 1 case of methicillin-resistant staphylococcus epidermidis.Conclusion SA is the main pathogenic bacteria of bone and joint purulent infection in children in the local area.The resistant rate of penicillin and the detection rate of MRSA are high in the hematogenous osteoarticular infections caused by SA,but no vancomycin resistant cases were found.