儿童阑尾炎病原学特点及抗菌药物使用分析

目的:回顾性分析我院阑尾炎患儿的病原学特点及致病菌分布情况,分析抗菌药物使用的合理性。方法:选取河北省儿童医院2013年1月至2017年12月收治的1383例确诊阑尾炎患儿,分析患儿病历资料及治疗效果,并随访出院患儿的预后情况。结果:患儿平均发病年龄5岁9个月,男女比例1.88∶1。共分离出719株致病菌,其中G-菌683株(95.0%),G+菌35株(4.9%);检出菌排序居前3位的依次为大肠埃希菌589株(81.9%)、铜绿假单胞菌56株(7.8%)、肺炎克雷伯菌12株(1.7%)。大肠埃希菌对亚胺培南、美罗培南、阿米卡星、多粘菌素、哌拉西林/他唑巴坦均有较高敏感率,敏感率>95.0%。结论:儿童阑尾炎主要致病菌以大肠埃希菌为主,不同病原菌对抗菌药物的敏感性不同,因此对脓液进行细菌培养和耐药性分析有利于临床的合理用药。

Etiological Characteristics and Application of Antibiotics in Children with Appendicitis

Objective:To retrospectively analyze the etiological characteristics of appendicitis in children and the distribution of pathogenic bacteria,and investigate the application rationality of antibiotics.Methods:A total of 1,383 cases of children with acute appendicitis in Hebei Children’s Hospital admitted from Jan.2013 to Dec.2017 were collected.Clinical data and treatment effects were analyzed,and the prognosis of discharged children was followed up.Results:The average age of onset was 5 years and 9 months,and the male to female ratio was 1.88∶1.A total of 719 strains of pathogens were isolated,including 683 strains of G-bacteria(95.0%)and 35 strains of G+bacteria(4.9%).The top three detected pathogens were respectively Escherichia coli of 589 strains(81.9%),Pseudomonas aeruginosa of 56 strains(7.8%),and Klebsiella pneumoniae of 12 strains(1.7%).E.coli was highly sensitive to imipenem,meropenem,amikacin,polymyxin,piperacillin/tazobactam,with the sensitivity rate of>95.0%.Conclusion:The most common bacteria in acute appendicitis were E.coli and different pathogens have different sensitivity to antibiotics.Therefore,bacterial culture and drug resistance analysis of the pus are beneficial to the rational use of drugs in clinical practice.