儿童吸入性和血源性金黄色葡萄球菌肺炎临床特点及其致病株耐药性分析

Clinical features of inhaled and blood-borne Staphylococcus aureus pneumonia and analysis of antibiotic resistance of the pathogen in children

摘要:

目的 比较吸入性和血源性金黄色葡萄球菌肺炎（Staphy1ococcus aureus pneumonia， SAP）的临床特点及分离菌株的耐药性。方法 回顾分析该院2008 年1 月至2013 年12 月确诊为SAP 的44 例患儿的临床资料。44 例患儿中，24 例为吸入性感染，20 例为血源性感染。结果 吸入性SAP 以3 岁以下婴幼儿多见，血源性SAP 以6 岁以上儿童多见。吸入性SAP 患儿咳嗽、喘息、湿罗音、呼吸困难和脓胸发生率显著高于血源性感染者（P<0.05），而血源性SAP 患儿高热、意识障碍、肝肾功能异常、化脓性骨髓炎、化脓性关节炎、脓毒血症和皮肤软组织脓肿发生率更高（P<0.05）。吸入性SAP 分离株对阿莫西林/ 棒酸、苯唑西林和头孢西丁耐药率显著高于血源性SAP 分离株，血源性SAP 分离株复方新诺明耐药率更高（P<0.05）。结论 吸入性SAP 好发于3 岁以下婴幼儿，呼吸道症状体征突出；血源性SAP 好发于6 岁以上儿童，感染中毒症状重，易致多器官感染和脏器功能损害。吸入性与血源性SAP 分离株的抗菌谱有差异。

Abstract:

Objective To compare the clinical manifestations between inhaled and blood-borne Staphylococcus aureus pneumonia (SAP) and the antibiotic resistance between the isolates of inhaled and blood-borne Staphylococcus aureus. Methods The clinical data of 44 pediatric SAP cases in the Children's Hospital, Chongqing Medical University from January 2008 to December 2013 were retrospectively analyzed. Twenty-four cases were identified as inhaled SAP, and 20 cases as blood-borne SAP. Results Inhaled SAP was more common in children younger than 3 years of age, while blood-borne SAP was more prevalent in children older than 6 years of age. Patients with inhaled SAP had significantly higher incidence rates of cough, wheeze, moist rales, dyspnea and empyema than those with blood-borne SAP (P<0.05). The patients with blood-borne SAP were more vulnerable to severe fever, unconsciousness, dysfunction of liver and kidney, pyogenic osteomyelitis, septic arthritis, sepsis, and abscess of skin and soft tissues (P<0.05). Inhaled SAP isolates had significantly higher rates of resistance to amoxicillin/clavulanic acid, oxacillin, and cefoxitin than blood-borne SAP isolates (P<0.05), while the latter had a higher rate of resistance to cotrimoxazole (P<0.05). Conclusions Inhaled SAP often occurs in children younger than 3 years of age, and the respiratory manifestations are commonly seen. Blood-borne SAP often occurs in children older than 6 years of age, with the infectious-toxic symptoms that result in multiple organ infection and dysfunction. The isolates of inhaled and blood-borne SAP have different antibiograms.