本文關(guān)鍵詞： 兒童 骨關(guān)節(jié)感染 細(xì)菌培養(yǎng) 藥敏實(shí)驗(yàn) 手術(shù)治療 耐藥菌　出處：《安徽醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:通過對當(dāng)前兒童急性骨關(guān)節(jié)感染病原菌的種類及耐藥性的總結(jié)分析,結(jié)合臨床治療的經(jīng)驗(yàn)體會,探討其合理有效的治療方法。方法:選擇自2011年1月至2015年03月在我科收治的急性骨關(guān)節(jié)感染患兒223例,其中骨髓炎71例,化膿性關(guān)節(jié)炎95例,骨髓炎合并化膿性關(guān)節(jié)炎20例,合并敗血癥等全身感染32例,合并多部位感染5例。年齡跨度在14天-14歲(平均5.4歲),就診時病程時間2-13天(平均5.6天),根據(jù)在院期間病原菌培養(yǎng)結(jié)果及藥敏試驗(yàn)資料,結(jié)合在院期間診治經(jīng)過,治療方式的選擇,抗生素的使用情況,以及后期半年內(nèi)隨診預(yù)后情況進(jìn)行分類比較和統(tǒng)計。結(jié)果:223例患兒共117例細(xì)菌培養(yǎng)陽性(52.5%),總共培養(yǎng)出革蘭陽性(G+)球菌93株,革蘭陰性(G㧟)桿菌30株,前三位分別為金黃色葡萄球菌85例(69%)、銅綠假單孢菌7例(5.7%)、大腸埃希菌5例(4.1%),無真菌及結(jié)核桿菌等特殊菌株,血膿培養(yǎng)均陽性6例,病原菌種類一致4例,耐藥菌株共38例,耐藥菌株比例為36.6%。各年齡段患兒耐藥菌比例相近。223例患兒全部入院即行抗感染治療。單純抗感染保守治療13例,合并手術(shù)治療210例,二次及以上手術(shù)6例,術(shù)后持續(xù)沖洗引流206例,其中抗生素持續(xù)沖洗引流90例,靜脈抗生素治療時間10-42天(平均16天),入院時病程1周以內(nèi)患兒198例,入院時病程7-13天患兒25例。半年內(nèi)隨訪總優(yōu)良率88.8%,預(yù)后差病例包括后遺骨關(guān)節(jié)功能障礙12例,骨骺板損傷造成遠(yuǎn)期肢體生長障礙6例,病理性脫位3例,大段骨壞死吸收2例,死亡2例。結(jié)論:金黃色葡萄球菌仍為兒童急性骨關(guān)節(jié)感染的主要致病菌,主要致病菌種類與國內(nèi)相關(guān)成人骨髓炎文獻(xiàn)報道大致相符,革蘭陰性桿菌(G-)感染無明顯上升,革蘭氏陰性桿菌感染多合并全身感染,血培養(yǎng)陽性者較多。多重耐藥菌比例明顯增多,合并全身嚴(yán)重感染病例增多,多重耐藥菌感染與患兒年齡段無關(guān),與病程時間及感染嚴(yán)重程度相關(guān)�？股刂委煈�(yīng)及時足量足程,培養(yǎng)陰性或結(jié)果未出前,需雙聯(lián)抗感染,抗生素選擇需兼顧常見G-、G+菌,后期據(jù)藥敏及時調(diào)整用藥,耐藥菌的增多需增大強(qiáng)效抗生素的應(yīng)用。手術(shù)指征明確者及時切開引流,術(shù)后局部灌洗,病程在1周內(nèi)的兒童急性骨關(guān)節(jié)感染治療效果明顯優(yōu)于1周以后,優(yōu)良率高。選擇合理有效的治療方式,最大程度的縮短病程時間,是兒童骨關(guān)節(jié)感染治療的關(guān)鍵。
[Abstract]:Objective: to summarize and analyze the types and drug resistance of pathogenic bacteria of acute osteoarthrosis infection in children at present, combined with the experience of clinical treatment. Methods: from January 2011 to March 2015, we selected 223 children with acute osteoarthritis, including 71 cases of osteomyelitis, 95 cases of suppurative arthritis, 20 cases of osteomyelitis combined with suppurative arthritis. 32 cases were complicated with septicemia and 5 cases with multiple site infection. The age ranged from 14 days to 14 years old (mean 5.4 years old), and the course of disease was 2-13 days (average 5.6 days). Combined with the course of diagnosis and treatment, the choice of treatment methods, and the use of antibiotics during the hospital period, Results 117 cases of bacterial culture positive and 52.5% positive bacteria were cultured in a total of 93 strains of Gram-positive G) cocci and Gram-negative G? ) of the 30 strains, the first three were Staphylococcus aureus in 85 cases, Pseudomonas aeruginosa in 7 cases, Pseudomonas aeruginosa in 7 cases, Escherichia coli in 5 cases, Escherichia coli in 5 cases, special strains such as fungi and Mycobacterium tuberculosis in 6 cases, positive in blood pus culture in 6 cases, and pathogenic bacteria in 4 cases. There were 38 drug-resistant strains, and the proportion of drug-resistant strains was 36.6. The rate of drug-resistant bacteria was similar in every age group. All 223 cases were treated with anti-infective therapy immediately after admission. There were 13 cases of simple conservative anti-infection treatment, 210 cases of combined surgical treatment and 6 cases of secondary or above operation. There were 206 cases of continuous irrigation and drainage after operation, 90 cases of which were treated with antibiotics. The duration of intravenous antibiotic therapy was 10-42 days (mean 16 days). 198 cases were treated with antibiotics within 1 week after admission. The total excellent and good rate of half a year follow-up was 88. 8%. The poor prognosis included 12 cases of residual bone and joint dysfunction, 6 cases of long term limb growth disorder caused by epiphyseal plate injury, 3 cases of pathological dislocation, 2 cases of large bone necrosis and absorption, 6 cases of long term limb growth disorder caused by epiphyseal plate injury, 3 cases of pathological dislocation, 2 cases of large segment osteonecrosis and absorption. Conclusion: Staphylococcus aureus is still the main pathogen of acute osteoarticular infection in children. The infection of Gram-negative bacilli was associated with systemic infection, and the positive cases of blood culture were more. The proportion of multidrug resistant bacteria increased obviously, and the cases of serious systemic infection increased, and the infection of multidrug resistant bacteria was not related to the age of the children. Antibiotic treatment should be sufficient in time, negative culture or before the result of the results, need to double anti-infection, antibiotic selection should take account of common G-G bacteria, according to the drug sensitivity timely adjustment of drug use. The use of strong antibiotics should be increased with the increase of drug-resistant bacteria. The patients with definite surgical indications should be cut and draining in time, local lavage after operation, and the treatment effect of acute osteoarticular infection in children with the course of disease within 1 week was obviously better than that after 1 week. The choice of reasonable and effective treatment methods to shorten the duration of disease to the greatest extent is the key to the treatment of children with osteoarthritis infection.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R726.8

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