儿童肠杆菌血流感染的临床特征及其病原菌耐药性

Drug resistance and clinical characteristics of bloodstream infections caused by Enterobacter in children

    摘要
  • 摘要:
    目的 分析儿童肠杆菌血流感染病原菌的耐药性、实验室指标及临床特征，为早期经验性治疗提供参考。
    方法 回顾性分析2017年1月-2023年12月广西壮族自治区妇幼保健院收治的29 d~12岁肠杆菌血流感染(单一感染)患儿302例的临床资料。分析不同年龄段患儿的检出肠杆菌及主要病原菌的耐药性，并根据预后情况将患儿分为预后良好组266例和预后不良组36例，比较两组患儿的实验室指标和临床特征。采用多因素logistic回归分析预后不良的危险因素。
    结果 感染病原菌以沙门菌属、大肠埃希菌和肺炎克雷伯菌为主。主要病原菌在各年龄段(29 d~6个月、＞6个月~1岁、＞1~2岁、＞2岁)的分布差异具有统计学意义(P＜0.001)。沙门菌对氨苄西林、氯霉素、磺胺甲噁唑/甲氧苄啶的耐药率分别为68.61%、54.01%和44.53%；大肠埃希菌对氨苄西林、磺胺甲噁唑/甲氧苄啶、头孢唑林的耐药率分别为83.33%、52.22%和47.78%；肺炎克雷伯菌对氨苄西林/舒巴坦、头孢呋辛、头孢唑林的耐药率均＞50%。低蛋白血症(OR=3.319)、脓毒症(OR=3.122)、脑室化脓性脑炎(OR=5.104)及培养阳性前青霉素类抗菌药物使用史(OR=3.374)是儿童肠杆菌血流感染预后不良的危险因素(P＜0.05)。
    结论 儿童肠杆菌血流感染多见于2岁以下患儿，主要病原菌为沙门菌属、大肠埃希菌和肺炎克雷伯菌，对青霉素类及头孢菌素类抗菌药物耐药率较高。临床应根据实验室指标及危险因素早期调整治疗方案，以改善患儿预后。

     

    Abstract:
    OBJECTIVE To analyze the drug resistance, laboratory indicators and clinical characteristics of bloodstream infections caused by Enterobacter in children, providing references for early empirical treatment.
    METHODS A retrospective analysis was conducted on the clinical data of 302 children (aged 29 days to 12 years) with bloodstream infections caused by Enterobacter (monomicrobial infections) admitted to the Maternity and Child Health Care of Guangxi Zhuang Autonomous Region from Jan. 2017 to Dec. 2023. The drug resistance of Enterobacter and major pathogens were analyzed across different age groups of children. Based on prognosis, the children were divided into a favorable prognosis group (266 cases) and a poor prognosis group (36 cases), and their laboratory indicators and clinical characteristics were compared. Multivariate logistic regression was used to analyze the risk factors for poor prognosis.
    RESULTS The major pathogens causing infections were Salmonella, Escherichia coli and Klebsiella pneumoniae. The distribution difference of major pathogens across age groups (29 days-6 months, >6 months-1 year, >1-2 years, >2 years) was statistically significant (P < 0.001). The drug resistance rates of Salmonella to ampicillin, chloramphenicol and sulfamethoxazole/trimethoprim were 68.61%, 54.01% and 44.53%, respectively. E. coli exhibited drug resistance rates of 83.33%, 52.22% and 47.78% to ampicillin, sulfamethoxazole/trimethoprim and cefazolin, respectively. K. pneumoniae showed drug resistance rates exceeding 50% to ampicillin/sulbactam, cefuroxime and cefazolin. Hypoalbuminemia (OR=3.319), sepsis (OR=3.122), ventricular purulent encephalitis (OR=5.104) and prior use of penicillin-class antibacterial drugs before culture positivity (OR=3.374) were identified as risk factors for poor prognosis of the children with Enterobacteriaceae bloodstream infections (P < 0.05).
    CONCLUSIONS Bloodstream infections caused by Enterobacter in children predominantly occur in those under 2 years of age, with Salmonella, E. coli and K. pneumoniae as the major pathogens, exhibiting high drug resistance rates to penicillin and cephalosporin antibacterial drugs. Clinical therapeutic regimen should be adjusted early based on laboratory indicators and risk factors to improve prognosis.

     

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