特应性皮炎皮损处金葡菌定植率及药敏分析

目的；探讨特应性皮炎（AD）皮损处病原茼分布特点，并检测主要病原菌的药物敏感性。方法：多中心随机双盲对AD患者皮损处采取微生物标本，并收取同期住院的非AD患者皮肤创伤处微生物标本，分别作AD组与对照组，标本接种于血平板、普通巧克力平板和麦康凯平板分区划线分离培养，应用MircoScanwalkaway96进行鉴定，并对所分离到的主要病原菌应用微量稀释法测定抗菌药物最低抑菌浓度（MIC）值，结果按美国临床实验室标准化研究所中的标准，耐甲氧西林用琼脂筛选试验证实（苯唑西林6btg／mL）。结果：于2010年9月-2011年9月从皮肤科门诊343例年龄2～15岁之间AD患者皮损部位获得331株病原菌。AD皮损处细菌检出率为96．5％，其中金葡菌176株占53．2％，其中MRSA65株，所占金葡菌的36．9％；对照组1373例患者分离到的病原菌总1195株，革兰阴性杆茼为主，金黄色葡萄球菌为197株，仅占所有病原菌的16．5％，其中MRSA119株，所占比例高迭60．4％。AD组金黄色葡萄球菌感染率远高于对照组（X2—133．38，P〈0．001），但MRSA所占金黄色葡萄球菌的比例却显著低于对照组（x0=39．263，P〈O．01）。AD组金黄色葡萄球菌对四环素、克林霉素、庆大、环丙沙星、左旋氧氟沙星、阿莫西林／棒酸、亚胺培南、头胞唑啉和复方新诺明等的耐药率低于对照组，其中AD组MssA菌株对红霉素、四环素、氯霉素、克林霉素等抗生素MIC均值高于对照组。结论：金葡菌感染与AD病情密切相关，AD患者高比例的金葡菌更可能是社区获得或源自身感染。针对金葡菌感染的AD患者，为保留万古霉素仅用于危及生命的感染，可选用奎奴普丁／达福普汀、利福平、复方新诺明和Linezolid等敏感抗生素控制感染，防止感染灶的扩散与病情加重。

Staphylococcus aureus Colonization and Antibiotic sensitivity analysis in Children with Atopic Dermatitis

Objective：Explore atopic dermatitis pathogenic bacteria distribution characteristics in skin lesions and the main pathogenic bacteria drug detection sensitivity. Methods：Adopt microbial specimens from skin lesions of AD patients and the non--AD patients using Multicenter, randomized, double--blind method. The specimens were inoculated on blood plate,usual chocolate plates and Mac Conkey for Streaking inoculation and separate culture. MircoScan Walkaway 96 was applied to confirm pathogenic bacteria. The minimal inhibitory concentration of antibiosis drugs were tested by microdilution method. The results were measured by The American clinical laboratory standardization institute. Methicillin was confirmed by screen- ing testa （oxacillin,6~g/mL）. Results331 strains pathogenic bacteria were isolated from the skin lesions of 343 AD patients,aging from 2-15 years old in 2010.9--2011.9. The bacterium relevance ratio on skin lesions was 96.5%. There included 176 strains Staphylococcus aureus which account for 53.2% among all bacterium and 65 strains MRSA counting for 36.9% among the Staphylococcus aureus. In the control group, the separation pathogenic bacteria included 1195 strains totally. As to bacterial distribution,Gram negative bacilli were predominant. The staphylococcus aureus in- cluded 197 strains,only accounting for 16.5~ ,and the MRSA contained119 strains,accounting for 60.4~. AD group staphylococcus aureus infection rate is much higher than the control group （X2 = 133.38,P~0. 001）, But the MRSA proportion of staphylococcus aureust was lower than those in the control group significantly （X2 =39. 263,P〈0.01）o Drug resistance rate of staphylococcus aureust to tetracycline,clindamycin,gentamicin,cip- rofloxacin,levofloxacin,imipenem, amoxicillin/clavulanic acid, cefazolint and sulfamethoxazole was lowed in AD than those in the control group. The mean MIC of MSSA to erythrocin,tetraeycline chloramphenicol and clindamycin in AD group were higher than those in the control group. Conclusion： The study revealed that there may be closely relation between Aureus infection and AD condition. The higher Staphylococcus aureus infection rate may caused by community acquired infections or endoautoinfection. For aureus AD patients infection,to maintain the vancomycin＇s only role for life-- threatening infection, other Sensitive antibiotics may be chosen, such as Quinupristin-dalfopristin, rifampin, SMZ and Linezolid to control infection, prevent focal infection and aggravate the illness state.