住院患儿抗生素的使用和耐药性调查

目的探讨我院近年来住院患儿抗生素使用现状和细菌耐药的发生率。方法利用我院信息中心、院控感科和化验室提供的数据和药敏情况，对2002年1月至2006年儿科、新生儿科9264例住院患儿进行回顾性调查，分析抗生素的使用现状和细菌的耐药性。结果我院小儿抗生素的使用率平均为88．25％。使用率前4位分别为：头孢噻肟钠、头孢唑啉钠、氨苄西林和阿奇霉素。病原学送检率为38．89％，主要致病菌对常用抗生素多重耐药，小儿肠道感染以福氏志贺氏菌感染为主，对第三代头孢菌素的耐药率较高，葡萄球菌对青霉素一直耐药，对万古霉素敏感。结论目前儿科医生对抗生素种类的选择比较慎重，抗生素的使用率和使用级别高，病原学送验率低，细菌耐药性高。监控和规范小儿抗生素的合理应用非常重要。     

897例儿童上呼吸道感染抗生素治疗回顾分析

目的了解儿童上呼吸道感染抗生素使用情况，分析抗生素治疗合理性。方法对住院及门诊上感患儿的抗生素使用情况进行分析。结果384例门诊上感患儿中抗生素的使用率为90．36％；513例住院上感患儿中抗生素使用率为99．42％。结论儿童上呼吸道感染治疗中抗生素使用率偏高。     

新生儿化脓性脑膜炎脑脊液病原菌分布和耐药性分析

目的：探讨新生儿化脓性脑膜炎脑脊液病原菌分布、抗生素敏感和耐药情况,为临床诊治提供实验室依据。方法对临床诊断的28例化脓性脑膜炎患儿脑脊液细菌培养和耐药性以及敏感性进行分析。结果28例化脓性脑膜炎患儿脑脊液病原菌分布：单菌株27例,双菌株1例。其中革兰阴性菌20株（68．96％）,革兰阳性菌8株（27．59％）,白色念珠菌1株（3．45％）。革兰阴性菌对氨苄西林、复方新诺明、哌拉西林的耐药率达80．00％以上,对头孢唑林、四环素、头孢噻肟的耐药率在60．00％以上。共检出产超广谱β-内酰胺酶菌8株,未检出对美罗培南耐药的革兰阴性菌。革兰阳性菌大部分对氨苄西林、复方新诺明、头孢西丁、红霉素耐药,未检出对万古霉素耐药的革兰阳性菌。结论新生儿化脓性脑膜炎脑脊液病原菌以革兰阴性菌为主,对多种抗生素耐药。     

泌尿系感染主要病原菌耐药性分析

目的 通过对引起泌尿系感染的主要病原菌耐药性分析，能更好地配合临床医生合理用药。方法 收集518例就诊患者行中段尿培养，按《全国临床检验操作规程》进行检测分析^[1]。结果 检出尿中细菌数高于10^4～10^5CFU／ml有240例，阳性率46．3％。其中革兰氏阴性菌177株(73．8％)；以大肠埃希菌为主(133株)阳性菌63株(26．2％)；又以表皮葡萄球菌为主(39株)。133株大肠埃希菌对8种抗生素的耐药性分别为：环丙沙星51．9%;阿米卡星8．3%;复方新诺明75．2%；四环素81．2%；氨苄西林88．0％；头孢唑啉48．9％；泰能3．8％；氨曲南14．3％。39株表皮葡萄球菌对8种抗生素的耐药性分别为：环丙沙星7．7％，阿米卡星5．1％，复方新诺明23．1％，四环素35．9％，青霉素76．9％，苯唑西林41．0％，克林霉素25．6％，红霉素41．0％。结论 长时间和较频的使用抗生素会导致耐药性的产生，提示在选择抗生素时必须慎重，防止滥用。     

小儿细菌性痢疾146例耐药情况分析

目的：分析小儿细菌性痢疾耐药性变化，探索最佳治疗方案。方法：对我院儿科1994至2002年间146例大便培养阳性细菌性痢疾患儿的菌群分布、药敏及治疗结果等进行分析。结果：痢疾杆菌菌群以福氏菌感染为主，占82．2％，其次为宋氏菌，占17．％。痢疾杆菌对头孢噻肟、头孢三嗪敏感性高，对庆大霉素、丁胺卡那、妥布霉素较敏感，对头孢唑啉、氟喹诺酮类敏感性下降明显，对氨苄青霉素、SMZco耐药性＞90％。＞6a患儿首选丁胺卡那加氟哌酸，＜6a患儿首选头孢噻肟。结论：随着抗生素的广泛应用，痢疾杆菌的耐药性不断产生，临床上应合理、交替使用抗生素以减少耐药性的产生。     

变形杆菌对常用抗生素的耐药分析

目的 了解变形杆菌的耐药特征及耐药机制。方法 采用纸片扩散(K—B)法对变形杆菌作常规药敏，并用头孢他啶和头孢他啶／克拉维酸；头孢噻肟和头孢噻肟／克拉维酸以及亚胺培南、头孢吡肟对产超广谱β—内酰胺酶和头孢菌素酶(AmpC酶)进行筛选，用“WHONET5”软件对药敏结果进行分析处理。结果 对常用抗生素的耐药率：青霉素G100％，氨苄西林25％，哌拉西林2．5％，头孢唑啉15％，头孢呋辛15％，头孢噻肟0％，头孢曲松0％，头孢吡肟0％，氨曲南0％，头孢西丁0％，亚胺培南0％，庆大霉素20％，阿米卡星0％，环丙沙星15％，复方新诺明47．5％，呋喃妥因87．5％。结论 青霉素、呋喃妥因、复方新诺明对变形杆茵耐药率高以外，其它β—内酰胺类、氟喹诺酮类、氨基糖苷类对其显示较强的抗菌活性，临床经验可选用。     

农村卫生室5岁以下儿童静脉用抗生素情况的调查分析

目的:了解农村卫生室5岁以下小儿静脉使用抗生素情况。方法:采用多级抽样的方法分别抽取南宁市邕宁县和武鸣县的1个乡的1个村，对这2个村的所有卫生室进行回顾性调查，翻阅各诊室一年内5岁以下儿童的处方，记录其静脉使用抗生素情况，输入数据库并进行统计。结果:6个诊室的10名村医一年内共对6219名5岁以下患儿进行了抗生素的静脉输液，占所有使用抗生素的90．0％，其中82．8％为发热儿童；72．9％为急性呼吸道感染的患儿，以咳嗽为主诉就诊的最多(45．8％)，此外冬、春季节以上呼吸道感染(URI)较多，夏、秋季节则以发热为主诉的较多；静脉用抗生素以青霉素为主，庆大霉素、丁胺卡那等耳毒性抗生素占29.6％，用抗生素二联治疗的患儿有1．4％；6个诊室患儿就诊的平均费用在4．8～13．5元之间，平均为8．2元。结论：村卫生室抗生素的使用以经验用药为主，缺乏规范的用药知识和经验；应加强对乡村医生诊疗和用药的培训，对其抗生素使用和输液条件进行管理以及对群众开展正确认识抗生素的广泛宣传。     

下呼吸道不动杆菌感染及药敏分析

目的：研究不动杆菌在下呼吸道的感染和药敏情况、指导临床合理用药。方法：取2000年1月－2002年7月间的住院患者的下呼吸道感染病人痰标本或经支气管镜无菌毛刷采取的标本，行细菌培养、常规生化鉴定，以纸片（K－B）法对分离株行药物敏感试验。结果：不动杆菌对所测各种抗生素均有不同程度的耐药，以敏感度由高到低前5位排列是亚胺培南95．6％、氨苄西林－舒巴坦68．9％、阿米卡星63％、头孢吡肟53．9％、头孢他定52．3％，其它敏感性在50％以上只有环丙沙星、氧氟沙星和头孢哌酮－舒巴坦。敏感性最差在15％以下分别是头孢唑啉、头孢氨苄、氨苄西林、头孢哌酮、头孢噻肟、头孢三嗪；头孢呋辛也在20％以下。结论：不动杆菌在下呼吸道感染病人痰标本中分离率高，耐药性广，临床治疗应根据药敏选择敏感抗生素。     

葡萄球菌临床分布情况及耐药趋势

目的了解葡萄球菌的临床分布情况及耐药趋势，为临床合理使用抗生素、控制医院感染提供参考。方法对海口市人民医院2005年送栓的临床标本分离的主要葡萄球菌分布及其药敏试验结果进行统计分析。结果在栓出的135株葡萄球菌中，金黄色葡萄球菌（SAU）与凝固酶阴性葡萄球菌（CNS）的栓出分别占36．3％和63．7％；SAU对青霉素、氨苄西林、红霉素、阿奇霉素的耐药率均在50％以上，对利福平、复方新诺明的耐药率在10％以下。CNS对青霉素、红霉素、阿奇霉素、苯唑西林、头孢曲松、氨苄西林的耐药率均在50％以上，对利福平的耐药率较低（18．6％）。SAU和CNS对青霉素的耐药率最高，分别为89．8％和89．5％，对万古霉素耐药率为0。结论海口市人民医院2005年栓出135株葡萄球菌中SAU占36．6％，以CNS占优势（63．7％）。其耐药趋势为：对青霉素耐药率最高，对万古霉素无耐药株。     

粤西地区基层医院小儿腹泻病抗生素使用情况分析

目的了解粤西地区基层医院小儿腹泻病抗生素使用情况，并探讨存在问题。方法对2003年6月1日-2005年8月31日在粤西地区基层医院住院的694例腹泻患儿抗生素使用情况、所导致的副作用等进行回顾性调查。结果694例患儿中有678例使用抗生素，占97．7％，其中使用一联抗生素302例，占44．5％；使用二联抗生素338例，占49．9％；使用三联抗生素38例，占5．6％。使用频率高的前5位抗生素是氨苄西林钠，头孢派酮、头孢三嗪、头孢噻吩、头孢噻肟钠，使用抗生素的患儿全部用过静脉途径给药。结论应加强对基层医院小儿腹泻病抗生素合理应用的指导和管理。     

广西南宁市5岁以下儿童细菌性脑膜炎病原学研究

目的 了解南宁市5岁以下儿童细菌性脑膜炎的病原学特点和致病菌的药物敏感性情况。方法2000年11月至2002年12月，在南宁市(含邕宁、武鸣县)所在乡镇卫生院以上的医疗机构进行监测，对发现疑似脑膜炎患儿采集脑脊液和血液进行细菌培养和采用kIrbv-Bauer纸片扩散法对病原菌进行药物敏感试验。结果 共检测采自1272例病例的1212份脑脊液标本和1193份血标本。分离出63株致病菌，其中从脑脊液标本中检出23株，从血液中检出40株。脑脊液和血液培养栓出最多的病原菌基本上一致，葡萄球菌最多，其次是肺炎双球菌、流感嗜血杆菌、肠杆菌科细菌。葡萄球菌对万古霉素、庆大霉素、苯唑西林及环丙沙星敏感率均在80％以上，而对青霉素和红霉素耐药率很高。沙门菌、大肠杆菌、阴沟肠杆菌等肠杆菌科细菌对环丙沙星、头孢菌素的敏感性较高。蛄论细菌性感染是南宁市婴幼儿脑膜炎致病因素之一。抗菌药物的选择使用应根据细菌药敏结果，以提高疗效，防止耐药性发生。     

Cerebrospinal fluid analysis, predictors of bacterial meningitis: a study in 312 patients with suspected meningial infection

Objective： Patients with cerebrospinal fluid （CSF） pleocytosis are routinely admitted to the hospital and treated with parenteral antibiotics, although few have bacterial meningitis （BM）. The aim of this study was to evaluate predictors to differentiate BM from aseptic meningitis （ASM）. Methods：The study was conducted in Razi hospital, a training center affiliated to Ahvaz Joundishapoor University of Medical Sciences in Iran. and all patients were 18 years old or above and were treated in the hospital between 2003 and 2007. Data of those who had meningitis, tested as CSF pleocytosis but had not received antibiotic treatment before lumbar puncture were retrospectively analyzed. Results： Among 312 patients with CSF pleocytosis, two hundred fifteen （68.9%） had BM and ninety seven （31.1%） had ASM. The mean age for patients with BM was （34.7 - 17.7） years （P = 0.22, NS）. Sixty percent of the BM cases and 61.2% of the ASM cases occurred in men （ P = 0.70, NS）. We identified the following predictors of BM： CSF-WBC count 〉 100 per micro liter, CSF-glucose level 〈 40 mg/dL, CSF-protein level 〉 80 mg/dL. Sensitivity, specificity, PPV, NPV of these predictors, and LR for BM are 86.5% ,52.6% ,80.2% , 63.7% and 104. 1 for CSF-WBC count and 72.1% , 83.5% , 90.6% ,57.4% and 164.2% for CSF glucose, and 49.7% , 91.8% , 93.4% ,45. 2% and 104.5% for CSF protein. Conclusion：The CSF WBC count should not be used alone to rule out bacterial meningitis. When it is combined with other factors such as CSF glucose and protein improved decision making in patients with suspected BM may occur.     

Surveying antibiotic use in a general teaching hospital

Four antibiotic surveys were carried out in a teaching hospital within the framework of an intensive drug monitoring system during 1976-1978. The proportion of inpatients receiving antibiotic therapy at any one time varied from 25% to 32%. Penicillin, ampicillin and co-trimoxazole were the most frequently used antibiotics. The use of cloxacillin increased over the survey period. Approximately 85% of presumed infections were treated before the results of microbiological tests became available. Between 29% and 39% of all courses of antibiotics were given for prophylaxis of infection. Between 13% and 30% of patients received more than one antibiotic concurrently; indication for such combined use appeared inadequate in 31% to 80% of courses.     

The latex agglutination test versus counterimmunoelectrophoresis for rapid diagnosis of bacterial meningitis

A modified latex agglutination (LA) test was compared with Gram-staining and counterimmunoelectrophoresis (CIE) for the rapid detection in the cerebrospinal fluid (CSF) of antigen to Haemophilus influenzae type b, Neisseria meningitidis groups A, B and C, Escherichia coli K1, Streptococcus pneumoniae and group B streptococci, seven frequent causes of bacterial meningitis in children. Of 50 CSF samples from patients with culture-proven bacterial meningitis 90% were correctly shown by the LA test to contain antigen of the responsible organism. Gram-staining revealed organisms in 80% of 45 of these samples. In 75% of the 40 samples that were of sufficient volume for CIE, positive results for the appropriate antigen were obtained. The concentration of antigen detected in the CSF by the LA test varied from undetectable to 800 000 ng/ml. Patients with a high concentration (more than 2000 ng/ml or a positive result at dilutions of CSF over 1/8) were significantly more likely to have a poor response to therapy (two died and two had persistent pleocytosis or bacteria in the CSF) than patients with a lower concentration (4/16 v. 0/18, P < 0.05). After appropriate therapy was begun the concentration of antigen fell dramatically, but measurable amounts of antigen persisted in the CSF for up to 6 days. The LA test detected bacterial antigen at concentrations 2 to 70 times below the lower limit detected by CIE. In seven additional patients who had received antibiotics before lumbar puncture was performed the LA test detected antigen from meningitis-causing bacteria even though cultures of the CSF were sterile. In another 145 patients who did not have meningitis the results of the LA test were negative. The LA test, done as described in this article, is easier to perform than CIE and should be a useful addition to the diagnostic tests carried out on the CSF of any patient suspected of having meningitis.     

Interferon in the Cerebrospinal Fluid of Children with Central Nervous System Disorders

Interferon was detected in the cerebrospinal fluid (CSF) of 26 of 51 children with aseptic meningitis, two of 44 with bacterial meningitis, and four of 118 with miscellaneous conditions including encephalitis, convulsive disorders and leukemia with neurological involvement. The geometric mean titre of interferon in mumps meningitis was seven to eight times higher than that in enteroviral meningitis; however, levels of interferon were not related to the concentration of leukocytes in CSF from these patients. Interferon titres were relatively greater at the height of the febrile response in children with mumps meningitis or enteroviral meningitis. There was no association between the presence of interferon in the CSF and the isolation of mumps virus or an enterovirus from the same specimen. Patients frequently developed homologous antibody one to three days after signs of aseptic meningitis, obscuring the relationship of interferon production to clinical improvement.     

神经外科术后颅内感染患者的抗生素使用

目的了解神经外科术后患者颅内感染情况及抗生素的使用。方法回顾分析2009年1月至2011年6月,首都医科大学附属北京天坛医院神经外科开颅术后脑脊液培养阳性患者的感染时间、致病菌分布及抗生素应用等情况。结果 2009年1月至2011年6月共行神经外科开颅手术21 067例,脑脊液培养阳性者253例,占1.20%,患者术后平均感染发生时间为7.2 d,术后病原学回报时间平均10.2 d。病原学培养结果中凝固酶阴性葡萄球菌所占比例最高,为28.85%,金黄色葡萄球菌为14.62%。所有脑脊液培养阳性患者均经验性使用抗生素治疗,在经验性治疗中,有33.4%的抗生素对致病菌敏感,目标性用药中82.9%为真正的抗生素敏感。结论目前脑脊液细菌学培养阳性率较低;其中凝固酶阴性葡萄球菌和金黄色葡萄球菌是患者神经外科术后颅内感染的主要致病菌;经验性抗生素治疗的准确性有待提高。     

Antibacterial therapy in general medical wards.

Information from a comprehensive drug surveillance programme is analysed to provide details of antibacterial drug use in medical wards. Some 28% of patients received antibacterial therapy, usually for the treatment of respiratory or urinary tract infections. The agents most frequently prescribed were ampicillin, co-trimoxazole and tetracyclines. Overall, 11% of recipients experienced one or more adverse effect of therapy. No significant bacterial growth was obtained from some 40% of specimens of sputum sent from patients. A plea is made for more rational use both of sputum culture in the investigation of patients with respiratory infection and of antibiotics in their treatment.     

Antibiotic use at Duke University Medical Center

A study of antibiotic use at Duke University Medical Center in June 1973 showed that 34.2% of all patients received antibiotics (43.6% surgical, 21.4% medical patients). Cephalothins were most frequently ordered for surgical patients, ampicillin sodium and penicillin G or penicillin V with potassium for other patients. A retrospective analysis of 50 randomly selected patients, according to the Kunin's categories of use, showed 64% of total antibiotic therapy as not indicated or inappropriately administered in terms of drug or dosage. These results are similar to previous reports of antibiotic surveillance and further establish the need for continuing education of prescribing physicians.     

细菌性脑膜炎患儿脑脊液中兴奋性氨基酸的变化及临床意义

目的　探讨细菌性脑膜炎患儿脑脊液中谷氨酸和天门冬氨酸的含量及临床意义。方法　根据细菌性脑膜炎的诊断标准选择 40例细菌性脑膜炎患儿作为细菌性脑膜炎组, 另选择 16例非神经系统疾病的患儿作对照组, 均于入院当天做腰穿留取脑脊液置-30℃冰箱保存待测。用高效液相色谱法测定脑脊液中谷氨酸和天门冬氨酸的含量。结果　细菌性脑膜炎患儿脑脊液中谷氨酸和天门冬氨酸的含量与对照组比较, 差别有显著性意义 (P均 <0。 05)。结论　细菌性脑膜炎的病理生理过程中存在着兴奋性氨基酸的兴奋毒性。兴奋性氨基酸的受体拮抗剂的应用有可能成为一种重要的治疗细菌性脑膜炎的新方法。