儿童急性阑尾炎致病菌及药物敏感谱分析

The analysis of pathogens and drug sensitivity spectrum in acute appendicitis in children

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phoenix 100细菌鉴定仪进行细菌培养及药敏试验，分析主要致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p一内酰胺酶菌株共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、睾丸酮丛毛单胞菌3种主要致病菌对哌拉两林／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〉161．9％。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。

Objective To study the major pathogens of the abdominal infection in children with acute appen- dicitis 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 phoenix 100 bacterial identifi- cation system for bacterial culture and sensitivity test, and the main types of pathogens and drug sensitivity were ana- lyzed,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 bacte- rial infection in 1 case,63 cases and 143 cases respectively;while two kinds in 0 case,26 cases, and 62 cases respec- tively;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 grant negative bacteria, 45 strains （ 11.66% ） of gram positive bacteria; extended - spectrum J3 - 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 % ） , Strepto- coccus 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 Amikacin i〉 88.1% ;the resistance rates of them to ampicillin,Tetracycline, Cotrimoxazole≥61.9%. The treatment pro- gram 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, germicuhure and susceptibility test should be enhanced, use antibacterial drugs appropriately.