儿童胃肠外科重症感染的抗菌药物治疗  

Antibiotic treatment of severe infections of gastrointestinal surgery in children

作　　者：王语[1] 金先庆[1] 李晓庆[1] 王佚[1] 向丽[1] 刘伟[1] 

机构地区：[1]重庆医科大学附属儿童医院胃肠外科,400014

出　　处：《重庆医学》2014年第9期1066-1068,1071,共4页Chongqing medicine

基　　金：国家自然科学基金资助项目(81370474)

摘　　要：目的：探讨儿童胃肠外科感染性疾病的特点及抗菌药物治疗原则。方法对该院胃肠外科2010～2012年住院感染性疾病患儿2625例（发病率占总住院人数的27．52％，其中耐药菌感染率为15．70％）的发病率、病种、致病菌、并发症、抗菌药物使用情况等进行回顾性分析。结果2625例中感染性疾病患儿中，感染性疾病中前5位分别为阑尾炎（40．72％）、肛周脓肿（21．53％）、阑尾周围脓肿（9．30％）、坏死性小肠结肠炎（3．73％）、脐炎（2．93％）。前3位致病菌分别为大肠埃希菌、肺炎克雷伯菌亚种、金黄色葡萄球菌。浅表耐药菌感染有255例，深部耐药菌感染有157例，使用1、2代头孢或半合成青霉素49例，使用3、4代头孢或β内酰胺／β内酰胺酶抑制剂346例，使用碳氢霉烯类抗菌药物或万古霉素17例。本组无死亡或广谱耐药菌医院感染患儿。结论84．3％小儿外科感染患儿仍对常用抗菌药物敏感，机会菌感染是其主要特点。儿童重症感染应根据临床特点及药敏试验合理使用抗菌药物，浅表耐药菌感染或深部耐药菌感染患儿使用限制性抗菌药物；深部耐药菌感染患儿使用特殊级抗菌药物。Objective To analyze the pattern of antibiotic use and antibiotic resistance tendency of gastrointestinal surgery in a tertiary children′s hospital .Methods 2 625 patients（which account for 27 .52% of all the hospilitalized patients ,the resistant rate was 15 .70% ） detailed morbidity ,entity ,bacteria ,complication ,antibiotic utilization was retrospectively reviewed using the hospital medical records from 2010 to 2012 .Results 2 625 patients the percentages of the top five disease category were ：appendicitis ac-counting for 40 .72% ,perianal abscess accounting for 21 .53% ,periappendiceal abscess accounting for 9 .30% ,necrotizing enterocol-itis accounting for 3 .73% ,omphalitis accounting for 2 .93% .The top three pathogen were ：escherichia coli ,klebsiella pneumoniae subsp ,staphylococcus aureus respectively .255 multi-resistant bacteria of the superficial infection patients and 157 of the invasive in-fection patients .49 multi-resistant infections were cured by first or second generation of cephalosporins and penicillinase-fast peni-cillin ,and 346 were cured by third or forth generation of cephalosporins and penicillinase-fast penicillin ,and 17 were cured by car-bapenem or vancomycin .No dead or multi-resistant hospital infectious case was reviewed .Conclusion The sensitive rates of surgi-cal infected patient were 84 .3% ,and opportunistic pathogen infection was the main characteristics .To aware the clinical character-istics and drug sensitive test is conductive to the reasonable use of antibiotics of severe infections .The cases of superficial resistant infection or invasive non-resistant infection tend to use restricted antibiotics .The cases of invasive resistant infection tend to use special antibiotics .

关 键 词：胃肠疾病 感染 致病菌 抗菌药 儿童 

分 类 号：R725.7[医药卫生—儿科]