儿科粪便培养菌群构成比及耐药性分析

Composition ratio and drug resistance of pediatric stool culture

目的:分析近年来我院儿科腹泻、肠炎粪便培养结果、耐药情况,提升合理用药水平。方法:回顾性分析2015年1月至2017年5月1 136份儿童粪便细菌鉴定结果及常见抗生素耐药情况。结果:本组1 136份儿童粪便共分离菌株114份(10.04%),包含鼠伤寒沙门菌82份,占71.9%,伤寒门菌5份,占4.4%,C群沙门菌4份,占3.5%,鸡沙门菌6份,占5.3%,弗氏志贺菌3份,占2.6%,类志贺邻单胞菌7份,占6.1%,沙门菌属7份,占6.1%,斯坦利沙门菌4份,占3.5%;不同性别儿童粪便培养菌阳性率比较差异无统计学意义(P>0.05);年龄分为3组,A组为≥1岁且<5岁,B组为≥5岁且<8岁,C组为≥8岁且≤15岁,其中A组与B组比较差异有统计学意义(χ~2=8.870,P=0.003),A组与C组比较差异有统计学意义(χ~2=9.994,P=0.002),B组与C组比较差异无统计学意义(P>0.05);沙门菌属对阿莫西林/克拉维酸钾的敏感率大于阿莫西林(χ~2=10.286,P<0.001),鼠伤寒沙门菌对阿莫西林/克拉维酸钾的敏感率大于阿莫西林(χ~2=116.747,P<0.001),鸡沙门菌对替卡西林/克拉维酸钾的敏感率大于替卡西林(χ~2=8.333,P=0.004),鼠伤寒沙门菌对替卡西林/克拉维酸钾的敏感率大于替卡西林(χ~2=32.903,P<0.001);本组114份菌株至少对1种抗生素耐药,占比最高的鼠伤寒沙门菌对美洛培南、亚胺培南敏感度最高,均为100.0%,对阿莫西林敏感度最低3.7%,其次为替卡西林13.2%。结论:鼠伤寒沙门菌是本院收治儿童腹泻、肠炎的主要致病菌,儿科粪便培养菌对美洛培南、亚胺培南敏感度最高,对阿莫西林、替卡西林敏感度最低。

Objective：To analyze pediatric diarrhea and colitis stool culture results and drug resistance in recent years and to improve rational drug use. Meth- ods：A retrospective analysis of 1 136 children fi＇om January 2015 to May 2017 on fecal bacterial identification and common antibiotic resistance was performed. Re- sults ：A total of 114 strains （9.68 % ） of 1 136 ehildreng stools isolated from the feces samples, including 82 strains （71.9 % ） of Salmonella typhimurium, 5 strains （4.4%.） of Typhimurium, 4 strains （3.5 %. ） of Salmonella serogroup C, 6 strains （5.3 %. ） of Salmonella gallinarum, 3 strains （2.6 % ） of Shigella flexneri, 7 strains （6.1% ） of Plesimonas shigelloides, 7 strains （6.1% ） of Salmonella and 4 strains （3.5 % ） of Salmonella stanley. There was no difference in the positive rates of stool culture in children of different ages and sexes （ P 〉 0.05）. The children were divided into three groups according to their ages ： Group A （ ages ≥ 1 year old but 〈 5 years old ）, Group B （ ages≥5 years old but 〈 8 years old ） and Group - （ ages≥8 years old but 〈 15 years old ）. There was difference between Group A and Group B （ X2 - 8. 870, P - 0. 003 ） ; There was difference between Group A and Group C （ X2 - 9. 994, P - 0. 002）. There was no difference between Group B and Group C（ P 〉0.05）. The sensitive rate of Salmonella to amoxieillin/Clavulanate is greater than amoxieillin （ χ^2 =10. 286, P 〈0. 001 ） ;The sensitive rate of Salmonella typhimurium to amoxieillin/Clavulanate is greater than amoxieillin（χ^2 = 116. 747, P 〈 0. 001 ） ; The sensitive rate of Salmonella gallinarum to tiear- eillin/Clavulanate is greater than tieareillin（ χ^2= 8. 333, P - 0. 004） ;The sensitive rate of Salmonella typhimurium to tieareillin/Clavulanate is greater than tieareillin （χ^2 =32. 903, P 〈 0. 001 ）. The 114 strains were resistant to at least one antibiotic. Among them, Salmonella typhimurium, accounting for the largest proportion , was most sensitive to meropenem and imipenem （ 100.0 % ）, followed by tieareillin （ 13.2 % ） and amoxieillin （ 3.7 % ） . Conclusion： Salmonella typhimurium is the main pathogen in children with diarrhea and enteritis. Pediatrics fecal culture bacteria were most sensitive to meropenem and imipenem, and the least sensitive to amoxieillin and tieareillin.