儿童鼠伤寒沙门菌肠炎细菌耐药性变迁及治疗分析  

Analysis of changes in bacterial drug resistance and treatment of Salmonella typhimurium enteritis in children

作　　者：周洁雯 马丙南 区静怡[2] ZHOU Jiewen;MA Bingnan;OU Jingyi(Department of Pediatrics,Guangzhou Eighth People's Hospital,Guangzhou Medical University,Guangzhou 510080,China;Department of Laboratory,Guangzhou Eighth People's Hospital,Guangzhou Medical University,Guangzhou 510080,China)

机构地区：[1]广州医科大学附属市八医院儿科,510080 [2]广州医科大学附属市八医院检验科,510080

出　　处：《天津医药》2024年第12期1282-1285,共4页Tianjin Medical Journal

基　　金：广东省医学科学技术研究基金(A2023180);广州市卫生健康科技项目(20221A011044)。

摘　　要：目的总结我院儿童鼠伤寒沙门菌肠炎细菌的耐药性变迁并对其治疗进行分析。方法纳入儿科就诊的鼠伤寒沙门菌肠炎患儿186例。分析儿童常用抗生素对鼠伤寒沙门菌的耐药情况,分析多重耐药菌年度及治疗前后变化情况。根据初始治疗抗生素及第一次药敏试验情况分为初始敏感组121例和初始不敏感组65例,比较2组患儿住院时间及粪便培养转阴时间。结果186例患儿分离出的鼠伤寒沙门菌对儿科常用的头孢类抗生素耐药率呈总体上升趋势,其中三代头孢菌素中的头孢曲松(43.6%)及头孢噻肟(35.5%)的耐药率较高。2017年—2019年多重耐药菌比例呈逐步上升趋势,而2020年—2023年比例较前有所回落。与治疗前比较,治疗10 d头孢哌酮舒巴坦、头孢噻肟及多重耐药菌的耐药率升高(P<0.016),但治疗1周上述3类药耐药变化差异无统计学意义。初始敏感组较初始不敏感组住院时间、粪便培养转阴时间均缩短(P<0.05)。结论儿童鼠伤寒沙门菌肠炎细菌耐药问题严峻,敏感抗生素的初始经验性治疗与合理的抗感染治疗有助于降低细菌耐药率及缩短住院时间。Objective To summarize changes in antibiotic resistance of Salmonella typhimurium enteritis in children in our hospital and analyze its treatment.Methods A total of 186 children with Salmonella typhimurium enteritis in the pediatrics department of our hospital were selected.The drug resistance of common antibiotics against Salmonella typhimurium for children was analyzed,and the annual and pre-/post-treatment changes of multi-drug resistant bacteria were also analyzed.Based on the initial treatment of antibiotics and the first drug sensitivity test results,patients were divided into the initial sensitive group(121 cases)and the initial insensitive group(65 cases).The hospital stay and fecal culture negative conversion time were compared between the two groups of children.Results Among the Salmonella typhimurium isolated from 186 children,the resistance rate of Salmonella typhimurium to commonly used cephalosporin antibiotics in pediatrics demonstrated an overall upward tendency.Among them,the resistance rates of ceftriaxone(43.6%)and cefotaxime(35.5%)were relatively high.From 2017 to 2019,the proportion of multi-drug resistant bacteria presented a gradual upward trend,while from 2020 to 2023,the proportion declined.The incidence of multi-drug resistant bacteria exhibited an increasing trend after treatment(P<0.05).After 1 week of treatment,there were no significant differences in the above three types of drug resistance changes.The hospital stay and the time for fecal culture to turn negative were both shorter in the initial sensitive group than those in the initial insensitive group(P<0.05).Conclusion The problem of bacterial resistance in Salmonella typhimurium enteritis in children is severe.Initial empirical treatment with sensitive antibiotics and a reasonable course of anti-infective treatment can help reduce the bacterial drug resistance rate and shorten the hospital stay.

关 键 词：鼠伤寒沙门菌 抗药性 细菌 肠炎 儿童 

分 类 号：R725.7[医药卫生—儿科]