婴幼儿泪囊炎病原菌分布及耐药性分析

Infant Dacryocystitis Pathogenic Bacteris Distribution and Drug Resistance Analysis

目的探讨引起婴幼儿泪囊炎主要致病菌特点及药物敏感性试验结果,为临床寻找治疗该疾病的有效抗生素和合理用药提供科学依据。方法对2015年1月—2016年12月到中山市博爱医院眼科门诊就诊并诊断为泪囊炎,年龄为1d至一岁的婴幼儿眼分泌物标本进行细菌培养及药敏分析,对结果进行回顾性分析。结果 (1)1769份标本中,检出致病菌的有577例,检出率为30.6%,其中有36株为混合感染。(2)致病菌以革兰阳性菌居多,依次为金黄色葡萄球菌、肺炎链球菌、流感嗜血杆菌、分别占致病菌的28.6%、22.6%、13.3%。(3)金黄色葡萄球菌对对万古霉素、环丙沙星、利福平和庆大霉素的敏感率在95%以上,对青霉素的敏感率为0%,耐甲氧西林的金黄色葡萄球菌(MRSA)检出率为17.2%。肺炎链球菌中青霉素敏感的肺炎链球菌(PSSP)为26.7%,青霉素非敏感的肺炎链球菌(PNSP)为73.3%;对万古霉素、氧氟沙星和利福平的敏感率为97%以上。流感嗜血杆菌对氨苄西林的耐药率为30.3%,β-内酰胺酶阳性率为30.3%。结论婴幼儿泪囊炎眼分泌物检出率最高的细菌为金黄色葡萄球菌、肺炎链球菌、流感嗜血杆菌,其中年龄<6月的婴幼儿多见。临床应根据眼分泌物细菌培养和药药敏试验结果,合理选用抗菌药物,以确保婴幼儿用药合理、安全、有效。

Objective To investigate the distribution and antibiotic sensitiviy of pathogenic bacteria isolated from infants with dacryocystitis, and to guide the rational use of antibiotic therapy in clinical practice. Melthods From 2015 January to 2016 December, a total of 1769 eye secretions were collected from outpatients and inpatients with dacryocystitis infant aged 1 day to 1 years in the Zhongshan Boai Hospital. Bacteria culture and drug sensitivity test were carried out on positive specimens. Retrospective analysis was performed on the results. Results Among the 1769 samples, 577 cases were pathogenic bacteria, of which 36 were mixed infection. The detection rate was 30.6%. Most of them were Staphylococcus aureus（28.60%）, Streptococcus pneumoniae（22.6%）, Haemophilus influenzae（13.3%）. Susceptibility results indicated that Staphylococcus aureu was more sensitive to vancomycin, ciprofloxacin, rifampin, gentamicin, all of which were above95%, but penicillin was 0%. About 17.2% of the Staphylococcus aureu strains were methicillin-resistant. The insusceptibility rate of Streptococcus pneumoniae to penicillin was 73.3% and the susceptibility rate was 26.7%. The susceptibility rate to vancomycin, ofloxacin, rifampin were above 97%. The resistance rate of Haemophilus influenzae to Ampicillin was 30.3%. The 13-1actamase positive rate was 30.3%. Conclusion The highest detection rate of eye secretions with infant dacryocystitis were Staphylococcus aureus, Streptococcus pneumoniae, Haemophilus influenzae. Dacryocystitis commonly attracts infant less than 6 moths old. Antibiotics use in clinic should be based on drug susceptibility test results of pathogenic bacteria, ensuring rational, safe and effective drug use on infant.