2005～2008年儿童菌痢病原菌与药敏分析及临床意义

目的了解儿童细菌性痢疾病原菌的分布特征及药敏特点，为临床更严谨更规范使用抗生素提供支持与依据。方法对2005年10月至2008年10月57例儿童菌痢的菌型、药敏及耐药性进行分析。结果儿童细菌性痢疾病原菌亚型分类中宋氏痢疾杆菌（D群）占14．0％，福氏痢疾杆菌（B群）占86．0％；痢疾杆菌对常用抗生素耐药率由低到高依次为头孢噻肟，丁胺卡那霉素，庆大霉素，头孢哌酮，头孢三嗪，头孢他啶，头孢唑啉，环丙沙星，氯霉素，复方新诺明，氨苄青霉素；痢疾杆菌单株对多种抗生素的总耐药率为39．2％，多重耐药率为43，9％，且各组间差异无显著性（χ^2=1．608，P=0．996），痢疾杆菌的耐药问题依然严重。结论新乡市区儿童细菌性痢疾病原菌亚型分类D组已呈明显上升趋势，但总体仍以B群感染为主（86％）；痢疾杆菌的耐药问题依然严重；对儿童菌痢选用抗生素应结合药敏首选头孢噻肟等第三代头孢类抗生素或头孢唑啉，年长儿也可选用丁胺卡那霉素、庆大霉素等氨基苷类，而以环丙沙星为代表的喹诺酮类药物不宜作为儿童尤其7岁以下小儿菌痢的备选药物；氯霉素、复方新诺明及氨苄青霉素已不再作为小儿菌痢的抗菌选择。

An analysis on the pathogenic bacteria and the rate of drug sensitivity with acute bacterial dysentery and its clinical implications

Objective To understand the distribution of the infectious diarrhea among children and changes of the drug sensitivity, in an attempt to provide support and evidence for effective use of antibiotics. Method The type, drug sensitivity and drug resistance of the infections diarrhea in 57 cases during October of 2003 and October of 2008 were analysed. Result Among the subtypes of the pathogenic bacteria of bacterial dysentery, ShigeUa sonnei （ Group D） accounted for 14, 0% and Shigella flexneri （Group B） 86.0%. Their drug resistance to common antibiotics were as follows, in ascending order： cefotaxime, amikacin, gentamicin, cefoperazone, ceftriaxone, ceftazidime, cefazolin, ciprofloxacin, chloramphenicol, cotrimoxazole, and ampicillin. The total rate of the moneclonal drug resistance to many different antibiotics was 39.2%, while the multi-drug resistance was 43.9% ,with no significant difference among different groups （χ^2 = 1. 608 ,P =0. 996） ,showing that the drug resistance of dysentery bacillus remains a serious problem. Conclusion There has been an increase in Group D in the urban areas of Xinxiang though 86% infected children are in Group B ;the drug resistance of dysentery ha- cillus remains a serious problem. In treatment the third generation cephalosporins such as cefotaxime or cefazolin can be chosen ,taking drug sensitivity into consideration,while aminoglyeosides represented by amikacin and gentamicin can be the best antibiotic for older children. Quinolones such as ciprefloxacin should be avoided especially for children younger than 7 years old. Chloramphenicol, cotrimoxazole and ampicillin are no longer used as anti-bacteria drugs for young children.