临床药敏实验对葡萄球菌性烫伤样皮肤综合征患儿使用抗菌药物的指导意义

Clinical drug sensitivity test in the use of antibacterials for children with Staphylococcus scalded skin syndrome

目的探究药敏实验对葡萄球菌性烫伤样皮肤综合征(SSSS)患儿使用抗菌药物的指导意义。方法选取我院63例SSSS患儿作为研究对象,采集患儿创面分泌物以及血培养进行细菌培养,柯-鲍氏(K-B)纸片扩散法进行药敏实验,统计致病菌种类及分布,并对耐药性葡萄球菌进行分析。结果63例患儿中共检测出58株病原菌,金黄色葡萄球菌(SAU)共36株,其中甲氧西林敏感SAU(MSSA)共26株(44.83%),耐甲氧西林SAU(MRSA)共10株(17.24%),MSSA、MRSA、表皮葡萄球菌主要分布在创面分泌物中,肺炎链球菌、肺炎克雷伯菌分布在血培养中。MRSA对替加环素、苯唑西林、红霉素、利奈唑胺、头孢西丁筛选、克林霉素、四环素、莫西沙星、左氧氟沙星的耐药性为100%,MSSA对复方新诺明、苄青霉素、头孢西丁筛选、庆大霉素、诱导性克林霉素耐药、环丙沙星的耐药性为0。MRSA对苯唑西林、苄青霉素、利奈唑胺、头孢西丁筛选、四环素、利福平的耐药性高于MSSA,差异有统计学意义(P<0.05)。结论SSSS患儿治疗前进行细菌学检测十分重要,应根据药敏分析结果合理使用抗菌药物。

Objective To explore the guiding significance of drug sensitivity test in antibiotic use for children with staphylococcal scalded skin syndrome ( SSSS). Methods Sixty-three children with SSSS in our hospital were selected as the research subjects,the wound secretions and blood culture were collected for germiculture. The drug sensitivity test was carried out by Kirby Bauer ( K-B) disk diffusion method,the species and distribution of pathogenic bacteria were counted,and the resistant staphylococci were analyzed. Results Among the sixty-three children,there were fifty-eight strains of pathogenic bacteria and thirty-six strains of Staphylococcus aureus ( SAU),of which there were a total of twenty-six strains of methicillin sensitive SAU ( MSSA)( 44. 83%),and a total of ten strains of methicillin resistant SAU ( MRSA)( 17. 42%). MSSA, MRSA, and Staphylococcus epidermidis were mainly distributed in wound secretion;Streptococcus pneumoniae and Klebsiella pneumoniae were distributed in blood culture. The resistance of MRSA to tigecycline,oxacillin,erythromycin,linezolid,cefoxitin screening,clindamycin,tetracycline,moxifloxacin, and levofloxacin was 100%. The resistance of MSSA to compound sulfamethoxazole,ampicillin,cefoxitin screening,gentamycin,induced clindamycin resistance,and ciprofloxacin was 0. The resistance of MRSA to oxacillin,benzylpenicillin, linezolid,cefoxitin screening,tetracycline,and rifampicin was higher than MSSA, the difference being statistically significant ( P < 0. 05). Conclusion It is important to carry out bacteriological detection before treatment in children with SSSS. Rational use of antibiotics should be based on the results of drug sensitivity analysis.