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目的掌握珠三角地区不同年龄段儿童腺样体、扁桃体肥大的病原菌分布及药敏情况。方法收集2 365例经临床确诊为腺样体、扁桃体肥大患儿的临床资料,按年龄分为4组,采集手术摘除的实质标本行细菌、真菌培养和药敏试验。结果 2 365例患儿中2 062例培养分离出病原菌,阳性率为87.2%,病原菌以肺炎链球菌(31.2%)、金黄色葡萄球菌(22.0%)和流感嗜血杆菌(20.0%)为主。A族链球菌是2岁~5岁组的主要检出病原菌,铜绿假单胞菌有随年龄增大而检出增多的趋势,肺炎链球菌、金黄色葡萄球菌、流感嗜血杆菌则集中分布在5岁~8岁组和8岁~11岁组。肺炎链球菌对红霉素、克林霉素的耐药率达到80%以上;金黄色葡萄球菌对青霉素类、大环内酯类抗生素有较高的耐药率,达到80%~90%;流感嗜血杆菌对喹诺酮类、阿奇霉素、加酶抑制剂复合物(如阿莫西林/棒酸)、二代及三代头孢菌素类均较敏感;铜绿假单胞菌对头孢菌素类的耐药性达到20%~30%,对碳青霉烯类的耐药率较低。结论不同年龄、地区儿童腺样体扁桃体肥大的病原菌分布存在一定差异,各地应根据实验室结果选择合理抗生素,减缓耐药菌的产生。
Objective To understand the distribution and drug susceptibility of pathogenic bacteria of adenoid and tonsillar hypertrophy in children of different ages in the Pearl River Delta Region. Methods The clinical data of 2 365 cases clinically diagnosed as adenoid and tonsil hypertrophy were collected and divided into 4 groups according to their age. Bacteria, fungal culture and drug susceptibility tests were performed on the specimens removed surgically. Results A total of 2 062 out of 2 365 children were isolated and cultured. The positive rate was 87.2%. The main pathogens were Streptococcus pneumoniae (31.2%), Staphylococcus aureus (22.0%) and Haemophilus influenzae (20.0%) . Group A streptococcus is the main pathogen detected in the group of 2-year-old to 5-year-old. Pseudomonas aeruginosa was detected with an increasing trend with age. Streptococcus pneumoniae, Staphylococcus aureus and Haemophilus influenzae were concentrated In 5 years old to 8 years old group and 8 years old to 11 years old group. Streptococcus pneumoniae to erythromycin, clindamycin resistance rate of more than 80%; Staphylococcus aureus penicillins, macrolides antibiotics have a higher resistance rate, reaching 80% to 90%; Haemophilus influenzae is sensitive to quinolones, azithromycin, enzyme inhibitor complex (such as amoxicillin / clavulanic acid), second and third generation cephalosporins; Pseudomonas aeruginosa to cephalosporins The drug resistance reaches 20% ~ 30%, and the resistance rate to carbapenems is low. Conclusion There are some differences in the distribution of pathogenic bacteria of adenoid tonsil hypertrophy in children of different ages and regions. The reasonable antibiotics should be selected according to the laboratory results and the generation of drug-resistant bacteria should be slowed down.