CAJ | 학술논문

目的研究儿童急性阑尾炎腹腔感染的主要致病菌及药物敏感性,指导临床合理使用抗生素.方法采集493例急性阑尾炎患者的脓液标本,使用phoenix1 00细菌鉴定仪进行细菌培养及药敏试验,分析主要敛病菌种类及药敏情况,随访治疗效果,总结主要致病菌及药物敏感谱.结果本组阑尾炎分为单纯性、化脓性及坏疽性阑尾炎,其中单种细菌感染分别有1例、63例、143例;2种细菌感染分别有0例、26例、62例;还有1例坏疽性阑尾炎为3种细菌感染,经比较不同病理类型的阑尾炎与细菌感染种类之间差异无统计学意义(x2=0.898,P＞0.05).493例标本中检出细菌296例(60.04％);分离出细菌386株,其中革兰阴性菌341株(88.34％),革兰阳性菌45株(11.66％);检出产超广谱β-内酰胺酶菌株共126株,占32.64％.前3位革兰阴性菌和革兰阳性菌分别为大肠埃希菌(65.28％)、铜绿假单胞菌(12.18％)、睾丸酮丛毛单胞菌(5.44％)和咽峡炎链球菌(5.18％)、星座链球菌(3.11％)、棉子糖肠球菌(0.78％).大肠埃希菌、铜绿假单胞菌、睾丸酮从毛单胞菌3种主要致病菌对哌拉西林/他唑巴坦、亚胺硫霉素、美罗培南和阿米卡星的敏感率≥88.1％;对氨苄西林、四环素、复方磺胺甲嗯唑的耐药率≥61.9％.根据药物敏感谱制定的抗生素治疗方案为头孢唑肟钠+哌拉西林/他唑巴坦+甲硝唑或奥硝唑.结论儿童急性阑尾炎的致病菌以革兰阴性菌为主,其中最常见的为大肠埃希菌,对临床常用的广谱青霉素类、头孢菌素类等抗生素有明显耐药性;应加强病原菌的检测和药敏试验,合理使用抗生素以减少耐药菌株的产生.
목적 연구인동급성란미염복강감염적주요치병균급약물민감성,지도림상합리사용항생소.방법 채집493례급성란미염환자적농액표본,사용phoenix1 00세균감정의진행세균배양급약민시험,분석주요렴병균충류급약민정황,수방치료효과,총결주요치병균급약물민감보.결과 본조란미염분위단순성、화농성급배저성란미염,기중단충세균감염분별유1례、63례、143례;2충세균감염분별유0례、26례、62례;환유1례배저성란미염위3충세균감염,경비교불동병리류형적란미염여세균감염충류지간차이무통계학의의(x2=0.898,P＞0.05).493례표본중검출세균296례(60.04％);분리출세균386주,기중혁란음성균341주(88.34％),혁란양성균45주(11.66％);검출산초엄보β-내선알매균주공126주,점32.64％.전3위혁란음성균화혁란양성균분별위대장애희균(65.28％)、동록가단포균(12.18％)、고환동총모단포균(5.44％)화인협염련구균(5.18％)、성좌련구균(3.11％)、면자당장구균(0.78％).대장애희균、동록가단포균、고환동종모단포균3충주요치병균대고랍서림/타서파탄、아알류매소、미라배남화아미잡성적민감솔≥88.1％;대안변서림、사배소、복방광알갑은서적내약솔≥61.9％.근거약물민감보제정적항생소치료방안위두포서우납+고랍서림/타서파탄+갑초서혹오초서.결론 인동급성란미염적치병균이혁란음성균위주,기중최상견적위대장애희균,대림상상용적엄보청매소류、두포균소류등항생소유명현내약성;응가강병원균적검측화약민시험,합리사용항생소이감소내약균주적산생.
Objective To study the major pathogens of the abdominal infection in children with acute appendicitis recently,and analyze the resistance of pathogens,combined with clinical efficacy,to learn about the spectrum of pathogens and sensitive antibacterial drugs,so as to guide rational use of antibacterial drugs.Methods Four hundred and ninety-three cases of pus specimens of acute appendicitis in children were tested by phoenix100 bacterial identification system for bacterial culture and sensitivity test,and the main types of pathogens and drug sensitivity were analyzed,and the treatment was followed up and the main pathogens and drug susceptibility spectrum were summarized.Results There were simple,suppurative and gangrenous appendicitis in this group,in which one single kind of bacterial infection in 1 case,63 cases and 143 cases respectively;while two kinds in 0 case,26 cases,and 62 cases respectively;and there was 1 case of gangrenous appendicitis with three kinds,though the comparison between pathological type appendicitis and bacterial infection type indicated that there was no significant difference (x2 =0.898,P ＞ 0.05).Four hundred and ninety-three cases of bacterial samples were detected with pathogens 296 cases,and the positive rate was 60.04％,386 strains of bacteria were isolated,341 strains (88.34％) of gram negative bacteria,45 strains (11.66％) of gram positive bacteria;extended-spectrum β-lactamase producing strains were detected in total 126 strains(32.64％).The top three gram negative bacteria and gram positive bacteria were Escherichia coli(65.28％),Pseudomonas aeruginosa (12.18 ％),Comamonas testosteroni (5.44％) and Streptococcus anginosus (5.18 ％),Streptococcus constellatus(3.11％),Enterococcus raffinosus (0.78％),respectively.The sensitive rates of Escherichia coli,Pseudomonas aeruginosa,Comamonas testosteroni to Piperacillin/Tazobactam and Imipenem (tienam),Meropenem and Amikaein ≥88.1％;the resistance rates of them to ampicillin,Tetracycline,Cotrimoxazole ≥61.9％.The treatment program was Ceftizoxime sodium + Piperacillin/Tazobactam sodium + Metronidazole or Ornidazole.Conclusions The main pathogens are gram-negative bacteria in children appendicitis,and the most common bacteria is Escherichia coli,and it has significant resistance to the broad-spectrum Penicillins,Cephalosporins;In order to reduce the emergence of drug-resistance strains,germiculture and susceptibility test should be enhanced,use antibacterial drugs appropriately.