儿科抗生素使用现状及细菌耐药性监测

Survey on bacterial resistance and antibiotics usage among paediatrics

目的探讨吉林地区儿科抗生素使用现状,监测细菌耐药性变化趋势,为儿科抗生素的合理使用提供参考指导。方法对2003年4月~2005年10月期间吉林市三级甲等医院儿科感染性疾病住院病例进行回顾性调查。采集患儿上呼吸道感染性标本,常规方法分离培养细菌和K-B法进行抗菌药物敏感性监测。结果662例感染病例均使用抗生素治疗,使用率为100%。病例中有12例（1.5%）根据药敏试验选用抗生素的记录。各种抗生素使用频次依次为头孢他定（55%）,罗红霉素（23%）和青霉素（22%）。242份上呼吸道感染标本共分离出366株细菌。革兰阳性球菌196株（53.6%）,以表皮葡萄球菌62株（31.6%）和金黄色葡萄球菌53株（27.0%）为主。革兰阴性杆菌170株（46.4%）,以肺炎克雷伯菌68株（40.0%）和大肠埃希菌49株（28.8%）为主。革兰阳性球菌对氨苄青霉素耐药率为86%,对其他抗生素的耐药率均超过18.5%。革兰阴性杆菌对氨苄西林耐药率高达79%,对其他抗生素的耐药率均超过26%。结论吉林地区儿童感染性疾病使用抗生素以青霉素、头孢类、大环内酯类为主,抗生素应用品种较单一,存在不合理使用抗生素现象。呼吸道分离出的革兰阳性球菌和革兰阴性杆菌对所使用抗生素有较高的耐药率。

Objective To investigate the present status of antibiotic use in paedlatrics＇ infectious diseases in Jilin regions and guide the rational usage of antibiotics. Method Cases of infectious diseases of childen from Jilin regions were randomly selected for a retrospective investigation from April 2003 to October 2005, including the treatment status, variety, frequency, average days of antibiotic usage. The 242 cases of specimens from the respiratory tract were coUected, and the bacteria were isolated and identified, and the susceptibility tests were done from April to October in 2005. Result The rates of antibiotic usage were 100% in all cases, but only 12 cases applied according to the susceptibility test. The using frequency of antibiotic were to cefazidime （55 % ）, toroxithromycin （23 % ） and to penicillin （25 % ）. The 366 strains of bacteria were isolated from 242 specimens including 196 strains of G＋ coccus accounting for 31.6 percents of Staph. epidermitidis and 27 percent of Staph. aureus, and 170 strains of G- baciUus accounting for 40 percent of K. pneumoniae and 28.8 percent of E. coll. The G＋ coccus resistance rates to Ampicillin were 86 %, the rates to other antibiotic were more than 18.5 %. The G- bacillus resistant rates to Ampicillin were 79%, the rates to other antibiotic were more than 26%. Conclusion The antibiotic usage rates of paediatrics＇ infectious diseases is 100%, the type of antibiotic is simple and used irrationally in Jilin regions. The bacteria from the respiratory tract have higher resistant rates to antimicrobial agents used in treating diseases.