儿童急性细菌性结膜炎病原菌分布及耐药性分析

Analysis of pathogenic bacteria and drug resistance in acute bacterial conjunctivitis in children

目的 分析儿童急性细菌性结膜炎患儿结膜囊分泌物中病原菌分布特点及对临床常见抗菌药物的耐药性。方法 采集276例急性细菌性结膜炎患儿的结膜囊分泌物标本,培养后进行菌种鉴定和药敏试验。将276例患儿按照随机数字法分为两组,第一组采用左氧氟沙星滴眼液治疗,第二组采用妥布霉素滴眼液治疗,连续治疗7d后,统计两组患儿的细菌清除效果和不良反应情况。结果 276例急性细菌性结膜炎患儿,共采集结膜囊分泌物276份,培养出致病菌280株,其中革兰阳性菌172株(61.43%,172/280),革兰阴性菌108株(38.57%,108/280)。革兰阳性菌主要为金黄色葡萄球菌(23.57%,66/280)、表皮葡萄球菌(20.71%,58/280)及肺炎链球菌(8.21%,23/280)。革兰阴性菌主要为流感嗜血杆菌(12.50%,35/280)、大肠埃希菌(9.64%,27/280)及铜绿假单胞菌(7.86%,22/280)。革兰阳性菌,对青霉素G、红霉素、克林霉素的耐药率高于60%,分别为84.88%、68.60%、66.28%,对妥布霉素、左氧氟沙星、环丙沙星、庆大霉素的耐药率低于20%,对万古霉素未产生耐药株。金黄色葡萄球菌对青霉素G的耐药率为80.30%,表皮葡萄球菌对青霉素G的耐药率为58.62%,耐药率差异有统计学意义(P<0.05)。革兰阴性菌对氯霉素、复方新诺明的耐药率高于50%,分别为50.93%、85.19%,对庆大霉素、左氧氟沙星、环丙沙星的耐药率低于20%,对美罗培南、亚胺培南、阿米卡星未产生耐药株。左氧氟沙星组,109例细菌清除,2例细菌部分清除,25例细菌未清除,2例细菌替换;妥布霉素组,123例细菌清除,15例细菌未清除。两组患者均未发生再感染情况,左氧氟沙星组细菌总清除率为80.43%,妥布霉素组细菌总清除率为89.13%,差异有统计学意义(P<0.05)。左氧氟沙星组,3例患者出现眼睑红肿,3例患者出现眼部瘙痒,2例出现眼球结膜充血,2例出现眼部烧灼感,总不良反应率为7.25%(10/138);妥布霉素组,2例患者出现眼睑红肿,2例患者出现眼部瘙痒,1例出现眼球结膜充血,1例出现眼部烧灼感,总不良反应率为4.35%(6/138)。两组患者总不良反应率差异无统计学意义(P>0.05)。结论 急性细菌性结膜炎患儿,病原菌主要为革兰阳性菌,以金黄色葡萄球菌、表皮葡萄球菌为主,对临床常见抗菌药物的耐药程度不同。妥布霉素滴眼液治疗急性细菌性结膜炎,细菌清除效果优于左氧氟沙星,未增加不良反应,具有较高安全性。

Objective To analyze the distribution characteristics of pathogenic bacteria in conjunctival sac secretions of children with acute bacterial conjunctivitis and their resistance to common clinical antibiotics.Methods276conjunctival sac secretion samples were collected from children with acute bacterial conjunctivitis.After cultivation and isolation,the bacterial identification and drug sensitivity tests were conducted.276 pediatric patients were divided into two groups according to the random number method.The first group was treated with levofloxacin eye drops,while the second group was treated with tobramycin eye drops.After 7 consecutive days of treatment,the bacterial clearance effect and adverse reactions of the two groups of patients were statistically analyzed.Results Among 276 children with acute bacterial conjunctivitis,a total of 276 specimens of conjunctival sac secretions were collected.280 strains of pathogenic bacteria were cultured,including 172 strains of Gram-positive bacteria(61.43%,172/280)and 108 strains of Gram-negative bacteria(38.57%,108/280).Gram positive bacteria were mainly Staphylococcus aureus(23.57%,66/280),Staphylococcus epidermidis(20.71%,58/280),and Streptococcus pneumoniae(8.21%,23/280).Gram negative bacteria were mainly Haemophilus influenzae(12.50%,35/280),Escherichia coli(9.64%,27/280),and Pseudomonas aeruginosa(7.86%,22/280).Gram positive bacteria had a resistance rate of over 60%to penicillin G,erythromycin,and clindamycin,which were 84.88%,68.60%,and 66.28%,respectively.The resistance rate to tobramycin,levofloxacin,ciprofloxacin,and gentamicin was less than 20%.They had not developed resistance to vancomycin.The resistance rate of Staphylococcus aureus to penicillin G was 80.30%,while that of Staphylococcus epidermidis to penicillin G was 58.62%.The difference in resistance rate was statistically significant(P<0.05).The resistance rates of Gram negative bacteria to chloramphenicol and compound sulfamethoxazole were higher than 50%,50.93%and 85.19%,respectively.The resistance rates to gentamicin,levofloxacin,and ciprofloxacin were lower than 20%.No resistant strains were produced against meropenem,imipenem,and amikacin.In the levofloxacin group,lo9 cases were cleared of bacteria,2 cases were partially cleared of bacteria,25 cases were not cleared of bacteria,and 2 cases were replaced with bacteria;In the tobramycin group,123 cases were cleared of bacteria,while 15 cases were not cleared of bacteria.Both groups of patients did not experience reinfection.The total bacterial clearance rate in the levofloxacin group was 80.43%,while the total bacterial clearance rate in the tobramycin group was 89.13%,with a statistically significant difference(P<0.05).In the levofloxacin group,3 patients experienced eyelid redness and swelling,3 patients experienced eye itching,2 patients experienced conjunctival congestion,and 2 patients experienced eye burning sensation.The total adverse reaction rate was 7.25%(10/138);In the tobramycin group,2 patients experienced eyelid redness and swelling,2 patients experienced eye itching,l patient experienced conjunctival congestion,and 1 patient experienced eye burning sensation.The total adverse reaction rate was 4.35%(6/138).The difference in total adverse reaction rates between the two groups of patients was not statistically significant(P>0.05).Conclusion In children with acute bacterial conjunctivitis,the main pathogenic bacteria were Gram positive bacteria,mainly Staphylococcus aureus and Staphylococcus epidermidis,with varying degrees of resistance to common clinical antibiotics.Tobramycin eye drops had a better bacterial clearance effect than levofloxacin in the treatment of acute bacterial conjunctivitis,without increasing adverse reactions,and had high safety.