小儿急腹症腹腔感染的细菌药敏试验及多因素分析

Multiple factors analysis on bacteria and susceptibility test in celiac infection of acute abdomen in children

目的探讨小儿急腹症腹腔需氧菌感染的菌种变迁、药敏,细菌和临床相关指标的关系。方法①标本及来源:选择山西医科大学第一医院小儿外科2005年1月至2006年12月的0～14岁的急腹症患儿160例,均经手术获取腹腔细菌标本。②实验步骤:标本→接种→培养→分离→鉴定→药敏试验。③指标及判定:观察相关临床项目(体温、血象、白蛋白、菌检结果、脏器有无穿孔、切口愈合等级、住院时间)。药敏试验,依据CLSI/NCCLS法判定。结果小儿腹腔细菌感染仍以大肠杆菌、绿脓杆菌和肠球菌为主。各病种间细菌培养阳性率差异有统计学意义(P<0.01);原发病脏器有穿孔组患者细菌培养阳性率高于未穿孔组(P<0.05)。以细菌培养结果为应变量,其他临床项目为自变量,进行多因素的回归分析,发现穿孔与否、白细胞总数与细菌培养阳性率有相关关系。结论①小儿阑尾炎发病率最高(76%);②小儿急腹症多数合并细菌感染(64%),需氧菌感染的致病菌谱与成人相似,产超广谱β-内酰胺酶的耐药菌值得重视;③第三代头孢类抗生素效果较好;④穿孔与否及白细胞总数与细菌培养阳性率有关系。

Objective To probe into the flora vidssitude, drug sensitivity in celiac aerobe infection of acute abdomen in pediatric surgical department and the correlation betwcven bacteria culture and clinical related indexes in children with acute abdomen. Methods （1）Source of cases and samples collection： A total of 160 childhood patients under 14 years old suffered acute abdcsnen pain from Jan. 2005 to Dec. 2006 hospitalized in the first hospital of Shanxi medical university were selected, from whom celiac bacteria samples have becn got by performing operation and have been detected. （2）Experiment procedure： Sample →inoculation→cuhure→isolation→idcntificatioin→drug sensitivity test. （3）Observation indexes and identification： Rdated clini- cal indexes induding body temperaturc, white blood cells count and differentiation, albumin, bacteria detection result, with or without perforation of intestine, healing grade of incision, length of hospital stzy. The results of drug .sensitivity tests were assessed according to CLSI/NOCLS roles. （4）Statistical analysis： On the basis of questionnaires, detailed relative dinical materials of patients were collected and analyzed by adopting SPSS. 13.0 statistical analysis software. Chi square and multiple factors regression have been selected. Results The main bacteria of childhood celiac infection are still Escherichia coli, aeruginosus Bacillus and enterccocd. There are statistical significances in terms of bacterial culture positive rate among children of various acute abdomen （P 〈 0.01 ）. The bacterial culture ,positive rate of acute abdomen children with primary perforation of intestine is higher than those of non-perforation children （P 〈 0.05）. Taking the results of bacterial culture as dependent variable and body temperature, white cell count and differentiation, blood albumin, postoperative healing grade of the indsions, and length of hospital stay as independent variables, muhiple factors regression analysis have been perfomed, which showed that there was correlation between acute abdomen children with or without intestine perforation and their white blood cells counts and bacterial culture positive rate. Conclusion（1）Among acute abdomen children, the incidence of appendidtis is the highest （76%）. （2）Most of acute abdomen children （64 % ） were complicated with bacterial infection, among which the main bacteria are still Escherichia coli, aeruginosus bacillus and entercocci. But the drng-resistance bacteria of ESBLs production should be paid more attention to. The pathogenic bacterial specman of aerobic bacteria of acute abdomen children is similar with that of the adults. Them was no great change. （3）The third generation of cephalosporin has better effect on most of these acute abdomen cases. （4）There was correlation between with or without intestine perforation of acute abdomen children and their white blood cells counts as well as bacterial culture positive rate.