儿童急性阑尾炎的病原学分析与临床用药探讨  

Etiological analysis and clinical medication of acute appendicitis in children

作　　者：毛建雄[1] 李苏伊[1] 罗燕[2] 肖东[1] 张翅[1] 任锋[1] 王智勇[1] Mao Jianxiong;Li Suyi;Luo Yan;Xiao Dong;Zhang Chi;Ren Feng;Wang Zhiyong.(Department of General ＆ Neonatal Surger;Operation Room, Municipal Children＇s Hospital, Shenzhen 518026, China)

机构地区：[1]深圳市儿童医院普外、新生儿外科,广东省深圳市518026 [2]深圳市儿童医院手术室,广东省深圳市518026

出　　处：《临床小儿外科杂志》2018年第4期278-281,共4页Journal of Clinical Pediatric Surgery

摘　　要：目的分析儿童急性阑尾炎的常见致病菌及药敏试验结果,探讨儿童急性阑尾炎的临床用药方法。方法选择本院收治的406例急性阑尾炎患儿的腹腔脓液做细菌培养及药敏试验,统计细菌培养及药敏试验结果,总结儿童阑尾炎常见的病原菌及对儿科常用药物的敏感性。结果 406例患儿中,118例(占29.1%)无细菌生长,195例(占48.0%)为大肠埃希菌,38例(占9.4%)为大肠埃希菌及铜绿假单胞菌,11例(占2.7%)为大肠埃希菌及肺炎克雷伯菌,9例(占2.2%)为肺炎克雷伯菌,其它细菌占8.6%。在培养所得的大肠埃希菌、铜绿假单胞菌、肺炎克雷伯菌的三种病原菌中,氨苄西林的耐药性分别为84.2%、95%、100%;哌拉西林的耐药性分别为0%、0%、11.1%;头孢吡肟的耐药率分别为27.2%、0%、22.2%;头孢曲松的耐药性分别为48.2%、100%、33.3%;头孢他啶的耐药性分别为34.2%、0%、22.2%;氨曲南的耐药性分别为35.9%、0%、22.2%;亚胺培南的耐药性分别为0%、0%、0%。结论大肠埃希菌是阑尾炎的主要致病菌,它对大多数抗生素都产生了耐药。铜绿假单胞菌对抗生素选择性耐药,肺炎克雷伯菌对大多数抗生素都敏感。Objective To explore the common pathogens and antimicrobial susceptibility test results for acute appendicitis to guide rational use of drugs in children. Methods For 406 cases of acute appendicitis in children with celiac pus ,bacterial culture and sensitivity test were performed for identifying common pathogens and determining sensitivity of common pediatric drugs. Results Among them, 118 cases （29.1% ） showed no bacterial growth,195 （48.0%） Escherichia coli,38 （9.4%） Escherichia coli and Pseudomonas aeruginosa,11 （ 2.7 % ） Escherichia coli and Klebsiella pneumoniae, 9 （2.2%） Klebsiella pneumoniae and （ 8.6 % ） other bacteria. For Escherichia coli ,Pseudomonas aeruginosa and KlebsieUa pneumoniae, the rates of ampicillin resistance were 84.2% ,95% and 100% ; piperacillin 0% ,0% , 11. 1% ; cefepime 27.2% ,0% ,22.2% ; ceflriaxone 48.2% ,100% ,33.3% ; ceftazidime 34.2% , 0% ,22.2% ; aztreonam 35.9% , 0% ,22.2% ; imipenem 0% , 0% ,0% .Conclusion As a major pathogen of appendicitis,Escherichia coli is resistant to most antibiotics. Pseudomonas aeruginosa is resistant while KlebsieUa pneumoniae remains sensitive to most antibiotics.

关 键 词：儿童 急性阑尾炎 病原学 药敏试验 

分 类 号：R725.7[医药卫生—儿科]