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目的对130例住院患儿细菌性腹泻的病原菌分布与耐药性进行分析,指导临床对细菌性腹泻患儿经验性抗菌药物方案选择。方法回顾性分析宁波市北仑区第二人民医院检验科2014年2月-2016年2月收治的130例细菌性腹泻患儿的临床资料,所有患儿临床相关资料如病案、实验室、粪便病原学培养及药敏检查结果保存完整,统计130例患儿粪便病原菌分布和构成、不同菌属(革兰氏阳性菌和革兰阴性菌)主要病原菌的耐药性及患儿预后情况,探讨细菌性腹泻患儿经验性抗菌药物治疗方案的选择注意事项。结果 130例患儿粪便标本经病原学培养、分离、纯培养及鉴别,检出病原菌共108株,革兰氏阳性菌22株(以金黄色葡萄球菌为主),革兰阴性菌86株(以沙门菌属、志贺菌属、致病大肠埃希菌为主)。金黄色葡萄球菌对临床首选抗菌药物苯唑西林、万古霉素、利奈唑胺、莫西沙星耐药率<30%。沙门菌属、志贺菌属、致病大肠埃希菌对头孢曲松、头孢他啶、对头孢噻吩、哌拉西林/他唑巴坦、复方新诺明、亚胺培南、美罗培南、奈替米星耐药率<30%。130例患儿经经验性抗菌药物结合敏感抗菌药物治疗,均获治愈。结论细菌性腹泻患儿病原菌构成较为复杂,临床医师应参考患儿的病原菌谱和药敏检测结果,按照药敏结果选择耐药率低于30%的抗菌药物作为经验抗菌药物治疗方案。
Objective To analyze the distribution and drug resistance of pathogenic bacteria in 130 hospitalized children with bacterial diarrhea, and to guide the clinical selection of empirical antibacterials in children with bacterial diarrhea. Methods The clinical data of 130 cases of bacterial diarrhea admitted to the Second People ’s Hospital of Beilun District in Ningbo from February 2014 to February 2016 were retrospectively analyzed. All the clinical data of the patients, such as medical record, laboratory, stool pathogen School culture and drug susceptibility testing results were well preserved. The distribution and composition of stool pathogens in 130 children were statistically analyzed. The drug resistance of major pathogens of different genus (Gram-positive and Gram-negative) and their prognosis were analyzed. Sexual diarrhea in children with experience in the choice of antimicrobial treatment options considerations. Results A total of 108 pathogenic bacteria, 22 Gram-positive bacteria (Staphylococcus aureus), 86 Gram-negative bacteria (Staphylococcus aureus) Salmonella, Shigella, pathogenic Escherichia coli based). Staphylococcus aureus on the clinical choice of the preferred antibacterials oxacillin, vancomycin, linezolid, moxifloxacin drug resistance <30%. Salmonella, Shigella and Escherichia coli causing pathogenicity to ceftriaxone, ceftazidime, cefalotin, piperacillin / tazobactam, cotrimoxazole, imipenem, meropenem, Mestar resistance rate <30%. 130 cases of children treated with experimental antibiotics combined with sensitive antibiotics, were cured. Conclusions The pathogen composition in children with bacterial diarrhea is rather complicated. Clinicians should refer to the pathogenic bacteria spectrum and susceptibility detection results of children and select the antibacterial drug with less than 30% resistance rate as experience antibacterial drug treatment plan.