小儿感染性腹泻临床特征与病原菌分布及耐药性分析  

Clinical characteristics of infectious diarrhea in children and distribution and drug resistance of pathogens

作　　者：胡玲[1] 王宝香[1] 梅红[1] 赵玉霞[1] HU Ling;WANG Bao-xiang;MEI Hong;ZHAO Yu-xia(Wuhan Children’s Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology,Wuhan,Hubei 430016,China)

机构地区：[1]华中科技大学同济医学院附属武汉儿童医院消化内科

出　　处：《中华医院感染学杂志》2019年第14期2237-2240,共4页Chinese Journal of Nosocomiology

基　　金：湖北省卫生厅基金资助项目(WJ2015MB249)

摘　　要：目的探讨小儿感染性腹泻的临床特征、病原菌分布及其耐药性情况。方法收集2015年6月-2017年12月儿科门诊诊治的980例感染性腹泻患儿,统计分析临床症状、粪便细菌培养和药敏试验结果。结果患儿均表现为腹泻、粪便性状异常,伴有发热42.24%、恶心呕吐21.63%、腹痛51.33%、脱水4.59%。粪便性状以稀水便、黏液便为主;共检出61例病原菌占6.22%,以沙门菌属31.15%、志贺菌属24.59%、弧菌属18.03%为主;2种主要沙门菌属病原菌对氨曲南、美罗培南、头孢他啶、磺胺甲噁唑/甲氧苄啶、亚胺培南、阿莫西林/克拉维酸敏感,耐药性0.00%~12.50%,福氏志贺菌对美罗培南、亚胺培南、阿莫西林/克拉维酸敏感,耐药性0.00%~8.33%,副溶血弧菌除氨苄西林外其他抗菌药物耐药性均较低0.00%~25.00%,金黄色葡萄球菌具有不均一耐药性。结论本地区感染性腹泻患儿的病原菌谱复杂,以沙门菌属、志贺菌属、弧菌属为主,且不同病原菌对抗菌药物耐药性差异较大,应结合粪便、病原学检查结果等合理选用抗菌药物治疗,抑制耐药性产生。OBJECTIVE To explore the clinical characteristics of infectious diarrhea in children and observe the distribution and drug resistance of pathogens. METHODS A total of 980 children with infectious diarrhea who were treated in pediatric outpatient department from Jun 2015 to Dec 2017 were enrolled in the study. The clinical symptoms and results of feces culture and drug susceptibility testing were statistically analyzed. RESULTS All of the children were characterized by diarrhea and abnormal trait of feces, 42.24% were complicated with fever, 21.63% had nausea and vomiting, 51.33% had abdominal pain, and 4.59% had dehydration. The feces were mainly characterized by dilute stool and mucous stool. Totally 61(6.22%) strains of pathogens were isolated, 31.15% of which were Salmonella, 24.59% were Shigella, and 18.03% were Vibrio. The drug resistance rates of 2 major species of Salmonella to aztreonam, meropenem, ceftazidime, sulfamethoxazole-trimethoprim, imipenem and amoxicillin-clavulanic acid varied from 0.00% to 12.50%. The drug resistance rates of Shigella flexneri to meropenem, imipenem and amoxicillin-clavulanic acid ranged between 0.00% and 8.33%. The drug resistance rates of Vibrio parahaemolyticus to all of the antibiotics varied from 0.00% to 25.00% except for ampicillin. Staphylococcus aureus strains varied in the drug resistance rates. CONCLUSION The spectrum of the pathogens isolated from the children with infectious diarrhea is complicated;Salmonella, Shigella and Vibrio are dominant among the pathogens and significantly vary in the drug resistance rates. It is necessary to reasonably use antibiotics based on the results of feces culture and etiological test so as to curb the emergence of drug resistance.

关 键 词：感染性腹泻 患儿 临床特征 病原菌 耐药性 

分 类 号：R725.7[医药卫生—儿科]