基于细菌耐药性变迁的儿童穿孔性阑尾炎抗菌药物使用策略分析  

Antibiotics Strategies for the Perforated Appendicitis in Children Based on the Transition of Bacterial Drug Resistance Pattern

作　　者：寿铁军[1] 程孝强 龚晟[1] 宋磊 李勇[1] SHOU Tiejun;CHENG Xiaoqiang;GONG Sheng;SONG Lei;LI Yong(Department of Pediatric Surgery,Ningbo Women and Children's Hospital,Ningbo 315012,China)

机构地区：[1]浙江省宁波市妇女儿童医院小儿外科,315012

出　　处：《中国全科医学》2020年第24期3070-3074,共5页Chinese General Practice

摘　　要：背景细菌耐药性一直是全球面临的问题,儿童穿孔性阑尾炎相关细菌对常用抗菌药物的耐药性处于不断变迁中,影响了抗菌药物治疗,给临床用药选择带来挑战。目的探究儿童穿孔性阑尾炎细菌耐药性变迁情况,并分析其抗菌药物方案的变化,旨在为临床提供合理的抗菌药物使用策略。方法回顾性收集2013年1月—2018年12月在宁波市妇女儿童医院接受诊治的461例穿孔性阑尾炎患儿的临床资料。按照住院时间将患儿分为两组:2013年1月—2015年12月住院患儿分至G1组(n=214),2016年1月—2018年12月住院患儿分至G2组(n=247)。分析患儿阑尾炎术中腹腔脓液的细菌培养和药敏试验结果,以及患儿的抗菌药物使用方案。结果461例患儿中,451例进行了细菌培养,10例未送检(原因系穿孔阑尾脓液极少、难以留取)。细菌培养结果中,大肠埃希菌、铜绿假单胞菌、咽峡炎链球菌检出株数均居G1组和G2组前3位,分别占G1组的60.8%(129/212)、10.4%(22/212)、6.1%(13/212)和G2组的59.5%(163/274)、12.0%(33/274)、4.7%(13/274)。G1组和G2组大肠埃希菌对头孢唑啉、头孢吡肟、呋喃妥因耐药情况比较,差异有统计学意义(P<0.05);G1组和G2组大肠埃希菌对氨苄西林舒巴坦、氨曲南、庆大霉素、复方新诺明、头孢曲松、氨苄西林、环丙沙星、厄他培南、阿米卡星、头孢替坦、亚胺培南、妥布霉素、哌拉西林他唑巴坦、头孢他啶、左旋氧氟沙星耐药情况比较,差异无统计学意义(P>0.05)。G1组和G2组铜绿假单胞菌对氨苄西林舒巴坦、复方新诺明、头孢曲松、氨苄西林耐药情况比较,差异有统计学意义(P<0.05);G1组和G2组铜绿假单胞菌对头孢唑啉、环丙沙星、头孢替坦、呋喃妥因、亚胺培南耐药情况比较,差异无统计学意义(P>0.05)。G1组抗菌药物方案中,前3位分别为头孢曲松钠+美洛西林钠/舒巴坦钠、头孢地嗪钠+哌拉西林钠舒巴坦钠+�Background Drug resistance of bacteria has always been a global problem.The resistance of bacteria related to perforated appendicitis in children to commonly used antibacterial drugs is consistently changing,which influences the therapeutic effect and poses challenges to clinical drug selection.Objective To explore the transition of bacterial drug resistance in children with perforated appendicitis and analyze the changes of antibacterial drug regimens in order to give advice rationally on clinical antibiotics strategy.Methods The clinical data of 461 children with perforated appendicitis treated in Ningbo Women and Children's Hospital from January 2013 to December 2018 were retrospectively collected.According to the time they were admitted to the hospital,children were divided into Group 1(G1,from January 2013 to December 2015)(n=214)and Group 2(G2,from January 2016 to December 2018)(n=247).The results of bacterial culture and drug susceptibility test of abdominal pus from appendicitis surgery,and antibacterial drug regimens were analyzed.Results Of the 461 patients,451 cases had bacterial cultures of abdominal pus,and 10 cases had no bacterial cultures(the reason was that the perforated appendix pus was too few to collect).Among the bacterial culture results,the number of detected strains of Escherichia coli,Pseudomonas aeruginosa,and Streptococcus anginosus were the top three in both G1 and G2,accounting for 60.8%(129/212),10.4%(22/212),and 6.1%(13/212)in G1,respectively,and 59.5%(163/274),12.0%(33/274),and 4.7%(13/274)in G2,respectively.The resistance of Escherichia coli to cefazolin,maxipime,and macrodantin in G1 and G2 was statistically significant(P<0.05).There were no significant differences in the resistance of Escherichia coli to ampicillin sulbactam,aztreonam,gentamicin,cotrimoxazole,ceftriaxone,ampicillin,ciprofloxacin,ertapenem,amikacin,cefotetan,imipenem,tobramycin,piperacillin tazobactam,ceftazidime,and levofloxacin between G1 and G2(P>0.05).The resistance of Pseudomonas aeruginosa to ampicillin su

关 键 词：阑尾炎 肠穿孔 儿童 细菌培养 药敏试验 耐药性 

分 类 号：R574.61[医药卫生—消化系统]