儿童细菌性痢疾病原菌与药敏的动态分析及临床意义

A dynamic analysis on the pathogenic bacteria and drug sensitivity of the bacterial dysentery among children and its implications

目的了解新乡市区儿童菌痢病原菌分布特征及药敏变化特点，为临床更严谨更规范使用抗生素提供支持与依据。方法对同一地区不同时间段儿童菌痢病原菌及其药物敏感率进行对比分析。结果新乡市区儿童菌痢病原菌亚型分布中D群已呈明显上升趋势（x^2=11．288，P=0．001），但总体仍以B群感染为主（86％）；痢疾杆菌对常用抗生素敏感率由高到低次为头孢噻肟、丁胺卡那霉素、庆大霉素、头孢哌酮、头孢三嗪、头孢他啶、头孢唑啉、环丙沙星、氯霉素、复方新诺明及氨苄青霉素；对丁胺卡那霉素等六种抗生素的敏感率无明显变化（x^2=6．974，P=0．223）；痢疾杆菌单株多重耐药率高达40％以上，且两组间差异无统计学意义（x^2=0．037，P：0．847）。结论新乡市区儿童菌痢病原菌亚型分布正在发生改变；痢疾杆菌的耐药问题依然严重；对儿童菌痢选用抗生素应结合药敏，首选头孢噻肟等第三代头孢类抗生素或头孢唑啉，年长儿也可首选以丁胺卡那霉素为代表的氨基甙类，而喹诺酮类药物常常不做为儿童尤其7岁以下小儿菌痢的备选药物，氯霉素、复方新诺明及氨苄青霉素不再作为小儿菌痢的抗菌选择。

Objective To investigate the distributional patterns and changes of the drug sensitivity of the pathogenic bacteria of the bacterial dysentery among the children in the urban areas of Xinxiang city, and to provide support and evidence for the clinical use of the antibiotics with precision. Methods To conduct analysis on the pathogenic bacteria of the children bacterial dysentery and its drug sensitivity among the children across different time periods in the same areas. Results It has been found that there is a tendency of increase in Group D in the distribution of the subtypes of the pathogenie bacteria of the children bacterialdysentery in Xinxiang（x^2 = 11. 288 ,P =0. 001 ） ,while the majority of the infected children are still in Group B（86% ） ;the drug resistance of the dysentery bacillus to the following common antibiotics varies of its rate in a descending order ： eefotaxime, amikacin, gentamicin, cefoperazone, ceftriaxone, ceftazidime, eefazolin, eiprofloxaein, ehloramphenicol, eotrimoxazole, and ampieillin ;there is no significant changes in the drug sensitivity to six antibiotics such as amikacin（x^2= 6. 974 ,P = 0. 223 ）. The multi-resistance to drugs of the monoelonal bacteria has reached over 40% , and there is significant difference between the two groups（x^2 = 0. 037 ,P = 0. 847 ）. Conclusion The distribution of the subtypes of the pathogenic bacteria of the children bacterial dysentery is undergoing changes ; the drug resistance of the dysentery bacillus remains a serious problem. In treatment the third generation cephalosporins or eefazolin such as cefotaxime can be the first option with a consideration of the drug sensitivity, and to the older children the aminoglycosides represented by amikacin and gentamicin can be the best antibiotics;while the quin- olones such as ciprofloxaein are not recommended for the treatment of the children and those younger than 7 years old in particular. And chloramphenieol, cotrimoxazole, and ampicillin are no longer used as anti-bacteria drugs for young children.