儿童侵袭性鲍曼不动杆菌感染的临床特征和耐药分析

Clinical characteristics and antibiotic resistance in children with invasive Acinetobacter baumannii infection

摘要:

目的：分析儿童侵袭性鲍曼不动杆菌感染（invasive Acinetobacter Baumannii infection，IABI）的临床和耐药特征。方法：回顾性分析2004年1月至2011年12月52例IABI患儿的临床和细菌药敏资料。结果：52例IABI患儿中1岁以下患儿占67%，发病以夏秋季为主（67%）。临床诊断败血症19例（37%）,尿路感染16例（31%），皮肤软组织感染12例（23%）。伴有基础疾病38例(73%)。医院获得和社区获得性感染分别占90%和10%。临床治愈及好转44例（85%），死亡8例（15%）。所有菌株对阿米卡星完全敏感，对亚胺培南的敏感率达82%，对氟喹诺酮类抗生素、头孢哌酮/舒巴坦的敏感率均超过70%，对头孢哌酮和氨曲南的敏感率仅为13%和8%，多重耐药率及泛耐药率分别为21%和17%。结论：儿童IABI好发于1岁以下，多数存在基础疾病；主要导致败血症、尿路感染和皮肤软组织感染，以医院获得性感染为主；IAB菌株的多重耐药和泛耐药现象已较严重。

Abstract:

OBJECTIVE: To analyze the clinical characteristics and antibiotic resistance in children with invasive Acinetobacter baumannii infection (IABI). METHODS: A retrospective analysis was performed on the clinical and drug sensitivity data of 52 children with IABI between January 2004 and December 2011. RESULTS: Of the 52 children with IABI, 35 (67%) were less than one year old and 35 (67%) had IABI in the summer and autumn, 19 (37%) of these children were clinically diagnosed with septicemia, 16 (31%) with urinary tract infection, and 12 (23%) with skin and soft tissue infection, and 38 (73%) of them suffered from underlying diseases. The incidence rates of hospital-acquired and community-acquired IABIs were 90% and 10% respectively; 44 cases (85%) were cured or showed improvement in symptoms, and 8 cases (15%) died. All the IAB strains isolated from these children were sensitive to amikacin, 82% of them were sensitive to imipenem, more than 70% were sensitive to fluoroquinolone and to cefoperazone/sulbactam, 13% were sensitive to cefoperazone, 8% were sensitive to aztreonam, 21% developed multidrug resistance, and 17% developed pan-drug resistance. CONCLUSIONS: IABI occurs more frequently in children under one year of age, and most children with IABI have underlying diseases. IABI mainly results in septicemia, urinary tract infection and skin and soft tissue infection and is mostly hospital-acquired. Multi-drug resistance and pan-drug resistance are severe in IAB strains.