小儿腹部感染需氧菌菌群分布及其耐药性研究

Study on the abdominal aerobic infections and antibiotic resistance in children

目的:观察小儿腹部感染需氧菌菌群分布及对抗生素的耐药状况。方法:选择腹部感染性疾病的患儿684例,在手术中采集腹水标本进行常规需氧菌培养和药敏试验。结果:684例中培养阳性467例,共检出需氧菌518株:其中大肠埃希菌376株(72.6%),克雷伯菌属35株(6.8%),肠杆菌属32株(4.2%),变形杆菌27株(5.3%)。铜绿假单胞菌12株(2.3%),肠球菌22株(4.2% ) ,其它14株(2.7%)。大肠埃希菌、克雷伯菌属、变形杆菌对氨苄青霉素的耐药率达78%～94%;对庆大霉素为43%～68%,而对丁胺卡那霉素仅为4%～16%;对第一代头孢菌素及第二代头孢菌素的耐药率为13%～51%,对第三代头孢菌素耐药菌株很少;对亚胺培南`万古霉素几乎无耐药菌株。铜绿假单胞菌对亚胺培南、丁胺卡那霉素、头孢他啶的耐药率<8%。结论:条件致病菌感染和内源性感染是小儿腹部感染的特点,由于耐药性增加,腹部感染旧“金三联”方案(氨苄青霉素加庆大霉素加灭滴灵)应被其它敏感抗生素替代。

Objective:To investigate the infection rates of aerobe and their drug resistance to common antibiotics in children's abdominal infectious diseases.Methods:684 ascites specimens collected from chldren with abdominal infectious diseases in routine aerobic way and drug sensitive tests were conducted.Results:Among the 684 specimens,aerobic cultures were positive in 467 cases(68.3%),with a finding of 518 strains,Top of the groups of strains was E.coli(376 strains,72.6%),then Klebsiella(35 strains,6.8%),Enterobacter(32 strains,6.2%),Bacillus proteus(27 strains,5.3%),Pseudomonas aeruginosa(12 strains,2.3%) and Enterococcus(22 strains,4.2%),the rest of the strains(14 strains,2.7%).The durg resistance rates of enterobacter to ampicillin and gentamicin were 78%～94%and 43%～68%separately.13%～15%of E.coli,Klebsiella,Bacillus proteus were resistance to first and second generation cephalosporin,while littlee of them to third generation cephalosporin.Among Enterobacter,most of the strains were sensitive to amikacin with drug restistance rates of 4%～16%.Even more,nearly all of the strains of E.coli were sensitive to imipenem and vancomycin,and the drug resistance rates of Pseudomonas aeruginosa to iminpenem,amikacin and ceftazidime were all below 8%.Conclusion:Abdominal infections in children were characterized by conditioned pathogen and endogenous infection.Ampicillin and gentamicin should be substituted by other sensitive antibiotic,due to their high drug resistance rates to abdominal aerobes.In the treatment of abdominal infectious diseases,it's very important for surgeons to select sensitive antibiotics,with the effect of culture and drug sensitivity test.