小兒菌血症之菌株及其對藥物感受性之變遷

Changes of Bacteremia Strains and Their Susceptibility to Antibiotics: A Five-Year Survey

江宗明(Tung-Ming Jhon) ； 張純懿(Tsun-Yi Chang)

《Acta Paediatrica Sinica》 29卷5期 (1988/10) Pp. 324-330

摘要

爲暸解中部地區兒科病童菌血症之年齡分佈，菌株及其對藥物感受性之變遷，分析了中國醫藥學院附設醫院，自民國七十一年一月至七十五年十二月止五年中，由兒科病房送到細菌室之血液培養共計5861件，其中分離出223株臨床有意義之菌株(3.8%)。這些菌血症之病童，在性別方面，男比女爲3:2。在年齡方面的分佈，年齡小於一個月的佔75%，年齡在1個月至2歲有17%，年齡在2至5歲及5至10歲各佔3%，年齡大於10歲者2%。在223菌株中，革蘭氏陽必菌佔47株，包括金黃色葡萄球菌26株，溶血性鏈球菌8株，腸球菌6株，肺炎雙球菌5株及其他革蘭氏陽性菌株2株。革蘭氏陰性菌有176株，包括大腸桿菌68株，沙門氏桿菌屬24株，大腸菌屬22株，克萊勃士桿菌屬15株，假單胞菌屬15株，變形菌屬14株，産檸檬酸菌屬10株，及其他革蘭氏陰性菌株8株。抗生素敏感性試驗顯出：1)90%之葡萄球菌對penicillin已有抗藥性，但對oxacillin敏感性仍然很高92%，不過這一、二年對oxacillin抗藥性的葡萄球菌比例已開始增加；2)肺炎雙球菌對penicillin之感受性仍然是百分之百有效；3)大腸桿菌對ampicillin之敏感性約45%，對amikacin敏感性很高，五年中均在93%以上。總而言之，菌血症發生在年齡小於1個月最多。菌血症分離之菌株，以革蘭氏陰性菌比革蘭氏陽性菌流行。金黃色葡萄球菌以oxacillin最有效，而大腸桿菌以amikacin最有效。

並列摘要

To understand the age distribution, bacteremic strains and their sensitivity to antibiotics in the central area of Taiwan, 5861 blood specimens were collected from a pediatric ward from January 1982 through December 1986. Two hundred and twenty-three bacterial strains (3.8%) were isolated from patients with a male to female sex ratio 3 to 2. The age distribution showed 75% below 1 month, 17% from 1 month to 2 years, 3% for both 2 to 5 and 5 to 10 years and 2% above 10 years.
In these positive cultures, there were 47 Gram positive, and 176 Gram negative, strains. The 47 Gram positives included staphylococcus aureus (26 strains), hemolytic streptococcus (8 strains), Enterococcus (6 strains), Streptococcus pneumoniae (5 strains) and others (2 strains). The 176 Gram negative strains included Escherichia coli (68 strains), Salmonella spp. (24 strains), Enterobacter spp. (22 strains), Klebsiella spp. (15 strains), Pseudomonas spp. (15 strains), Proteus spp. (14 strains), Citrobacter spp. (10 strains) and others (8 strains).
Sensitivity tests with antibiotics showed that 90% of the Staphylococcus aureus was resistant to penicillin, but still very sensitive to oxacillin (92%). However, in the past two years, resistance to oxanillin increased gradually. The sensitivity of Streptococcus pneumoniae to penicillin was 100%. Only 45% of the Escherichia coli was sensitive to ampicillin but, to amikacin, it was very sensitive, even upto 93% in the recent five years.
In conclusion, the highest age incidence for infection was below one month. Analysis of the bacteremic strains, showed the Gram negatives were more prevalent than Gram positives. The drug of choice for Staphylococcus aureus was oxacillin and, for Escherichia coli, was amikacin.

並列關鍵字

bactermia ； antibiotic sensitivity