小儿细菌性腹泻病原菌分析及耐药变迁

Analysis of Pathogenic Bacteria in Children with Diarrhea and Antibiotic Resistance

目的 :了解引起小儿细菌性腹泻的主要病原菌及其耐药的变迁。方法 :肠道病原菌常规分离鉴定方法。结果 :从 2 0 15 7例北京儿童医院急性腹泻患者粪便中分离出沙门菌属、志贺菌属、变形菌属及致病性大肠杆菌共 13 44株 ,总检出率为 6.7%。其中志贺氏菌属 10 3 0株 ,检出率为 76.7%。福氏志贺菌占志贺菌属 82 .0 % ,其次是宋内志贺氏菌占 17.7%。沙门菌属 178株 ,总检出率为 13 .2 %。变形杆菌属 12 4株 ,总检出率 9.2 % ,以奇异变形杆菌为主。致病大肠杆菌 12株 ,总检出率 0 .9%。福氏痢疾杆菌对 β-内酰氨酶类耐药率有所增加 ,阿莫西林 /棒酸的耐药率也有所增加 ;对喹诺酮类抗生素的耐药率有所下降 ;对头孢三代类几乎都是敏感的 ;对氯霉素高度耐药。宋内氏痢疾杆菌、沙门氏痢疾杆菌对喹诺酮类的耐药率有所下降。结论 :小儿细菌性腹泻以志贺氏菌为主 ,其中又以福氏痢疾杆菌占绝对优势。儿童感染的福氏痢疾杆菌对以前常用的氯霉素、氨苄青霉素、哌拉西林、阿莫西林 /棒酸的耐药率增高 ;对头孢三代都较敏感。环丙沙星治疗福氏痢疾杆菌仍然是敏感的。

Objective To investigate pathogenic bacteria in children with diarrhea and changes of their antibiotic resistance. Method: Routine identification methods were used to isolate pathogenic bacteria of intestines. Results 20 157 stool specimens were collected from children with acute diarrhea in Beijing Children's Hospital. By using routine identification methods, 1 344 strains of pathogenic bacteria were isolated, which were salmonella SP, shigella, proteus and enteropathogenic E. coli (EPEC). The isolating rate was 6.7 %. Among them, 1 030 strains were shigella (76.7 %). 178 strains were salmonella SP (13.2 %), 124 strains were proteus (9.2 %), 12 strains were EPEC (0.9 %). 82 % of shigella were S.flexneri, 17.7 % were sonnies. S.flexneri, which were β lactamase resistant and Amoxclin clavicacid resistant, were increasing, while strains, which were resistant to Amino glycosides and Quino lones, were decreasing. Most of them were sensitive to 3rd generation and resistant to cloramphenicol. The resistant rate of sonnies and salmonella to Quino lones and Amino glycosides were decreasing. Conclusion The major pathogen of bacteria diarrhea in children is shigella and most of them are S.flexneri. The resistant rate of S.flexneri to clormpaenicol, Amoxcillin, piperacillin and AMC are increasing. But most of them are sensitive to 3rd generation. Strains of cip resistance and Amino glycosides resistance are decreasing. So 3rd generation is a good choice to diarrhea with S.flexneri. In order to cure diarrhea resulted by sonnies, physicians should think about Ampicillin first.