目的 调查深圳地区综合性医院门诊幽门螺杆菌（Hp）对8种常见抗菌药物的耐药情况。方法 采集13C呼气试验阳性的患者胃黏膜标本313例，进行Hp分离培养及抗菌药物敏感性试验。结果 313例患者分离培养得到247例Hp菌株，培养阳性率78.91%，不同性别、不同年龄患者Hp分离培养阳性率比较差异无统计学意义（P＞0.05）。Hp对甲硝唑、克拉霉素、左氧氟沙星、利福平、阿莫西林、四环素、呋喃唑酮、庆大霉素耐药率依次为88.66%（219/247）、38.46%（95/247）、38.06%（94/247）、4.05%（10/247）、1.21%（3/247）、0.40%（1/247）、0.40%（1/247）、0（0/247）。双重耐药率为38.46%（95/247），其中Hp对克拉霉素+甲硝唑组合耐药率最高（18.62%，46/247），对甲硝唑+左氧氟沙星耐药率居其次（17.00%，42/247）。多重耐药率为19.84%（49/247）。不同年龄、性别患者双重耐药率、多重耐药率比较差异均无统计学意义（P＞0.05）。结论 深圳地区分离的Hp菌株对甲硝唑、克拉霉素、左氧氟沙星耐药率相对更高，且双重耐药、多重耐药情况严重。
Objective To investigate the antibiotic resistance of Helicobacter pylori（Hp）to eight commonly used antibiotics in outpatients of general hospitals in Shenzhen．Methods Gastric mucosal samples were collected from 313 patients who tested positive for the 13C breath test，and Hp strains were isolated and cultured．Antibiotic susceptibility testing was performed on the isolated Hp strains．Results Of the 313 patients，247 Hp strains were isolated，with a culture-positive rate of 78.91%．There was no significant difference in culture-positive rates between different genders and age groups（P＞0.05）．The resistance rates to metronidazole，clarithromycin，levofloxacin，rifampicin，amoxicillin，tetracycline，furazolidone，and gentamicin were 88.66%（219/247），38.46%（95/247），38.06%（94/247），4.05%（10/247），1.21%（3/247），0.40%（1/247），0.40%（1/247），0（0/247），respectively．The dual resistance rate was 38.46%（95/247），with the highest combination resistance observed in clarithromycin + metronidazole（18.62%，46/247），followed by metronidazole + levofloxacin（17.00%，42/247）．The multi-drug resistance rate was 19.84%（49/247）．There were no significant differences in dual resistance rates（P＞0.05）or multiple resistance rates（P＞0.05）between different age groups and genders．Conclusions The Hp strains isolated in Shenzhen exhibited relatively higher resistance rates to metronidazole，clarithromycin，and levofloxacin，with substantial dual and multi-drug resistance．
目的 分析阿莫西林克拉维酸钾与第三代头孢类抗菌药联合应用于新生儿肺炎患儿的应用效果及其对患儿肠道菌群的影响。方法 选择在2021年2月—2022年11月期间于我院新生儿科接受相关治疗的100例新生儿肺炎患儿,依照简单随机化法将患儿分为研究组（n=50）及参照组（n=50）。给予参照组常规新生儿肺炎治疗,在此基础上给予研究组患者阿莫西林克拉维酸钾与第三代头孢类抗菌药的联合治疗。治疗结束后对比两组患儿的血清因子水平、肠道菌落情况、临床疗效以及不良反应发生情况。结果 治疗前,两组患儿的血清因子水平、肠道内菌群数量比较差异无统计学意义（P>0.05）,治疗后两组患儿的降钙素原（procalcitonin,PCT）、C-反应蛋白（C-reactive protein,CRP）、白细胞计数（white blood cell count,WBC）、肠球菌、肠杆菌、双歧杆菌以及乳酸杆菌水平均有改善（P<0.05）,其中研究组的PCT、CRP、WBC、肠球菌、双歧杆菌以及乳酸杆菌数量低于参照组,而研究组的肠杆菌数量高于参照组;同时研究组的临床有效率（94.00%）与参照组的临床有效率（86.00%）比较差异无统计学意义（P>0.05）;两组患儿的不良反应发生率比较差异无统计学意义（P>0.05）,但其中研究组腹泻的发生率高于参照组（P<0.05）。结论 在对新生儿肺炎患儿进行治疗时采取阿莫西林克拉维酸钾单纯治疗与阿莫西林克拉维酸钾+第三代头孢类抗菌药（头孢他啶）的临床疗效相当,联合用药虽能更为显著地减少患儿机体的细菌数量,改善血清因子水平,但更易发生腹泻的并发症,且为了减少耐药性,应适当采用单独用药。
Objective To analyze the application effect of amoxicillin clavulanate potassium combined with third-generation cephalosporin antibiotics in children with neonatal pneumonia and its impact on the intestinal microbiota．Methods From February 2021 to November 2022,100 newborns with pneumonia who received relevant treatment in the Department of Neonatology at the First People’s Hospital of Shangqiu City were randomly divided into a study group（n=50）and a reference group（n=50）using a simple randomization method．Routine treatment was provided for neonatal pneumonia in the reference group,and on this basis,a combination treatment of amoxicillin,clavulanate potassium,and third-generation cephalosporin antibiotics was applied on the study group patients．After treatment,the serum factor levels,intestinal colony status,clinical efficacy,and incidence of adverse reactions were compared between the two groups of children．Results Before treatment,there were no statistically significant differences in serum factor levels and intestinal microbiota between the two groups of children（P>0.05）．After treatment,the levels of procalcitonin（PCT）,C-reactive protein（CRP）,white blood cell count（WBC）,Enterococcus,Enterobacter,Bifidobacterium,and Lactobacillus in the two groups of children improved（P<0.05）,with the levels of PCT,CRP,WBC,the number of Enterococcus,Bifidobacterium,and Lactobacillus in the study group was lower than that in the reference group,while the number of Enterobacter in the study group was higher．There was no statistically significant difference（P>0.05）in the clinical response rate between the study group（94.00%）and the reference group（86.00%）．There was no statistically significant difference in the incidence of adverse reactions between the two groups of children（P>0.05）,but the incidence of diarrhea in the study group was higher than that in the reference group（P<0.05）．Conclusions The clinical efficacy of amoxicillin clavulanate potassium alone and amoxicillin clavulanate potassium+third-generation cephalosporin antibiotics（ceftazidime）in the treatment of newborns with pneumonia is comparable．Although the combination therapy can significantly reduce the number of bacteria in the body of children and improve serum factor levels,it is more prone to complications of diarrhea．In order to reduce drug resistance,separate medication should be appropriately used．
谨慎处理报告的抗生素过敏是抗生素管理的一个重要方面。荷兰抗生素政策工作组（SWAB）于2023年4月发布了《SWAB指南：疑似抗生素过敏的处理方法》以下简称（指南）,指南依据对疑似抗生素过敏人群的比较和结果问题研究,对每个问题进行系统的文献检索,并通过证据评价系统对现有最佳证据进行审查后制定。指南就疑似抗生素交叉过敏,速发型过敏和迟发型过敏等问题进行阐述,为报告抗生素过敏患者选用抗生素治疗的床旁决策提供基于现有研究的循证建议。本文对指南涉及12个关键问题进行解读,以期为疑似抗生素过敏患者临床治疗提供参考,使患者获益。
Careful handling of reported antibiotic allergies is an important aspect of antibiotic management．In April 2023,the Dutch Working Group on Antibiotic Policy（SWAB）issued the SWAB Guide：“The Dutch Working Party on Antibiotic Policy（SWAB）guideline for the approach to suspected antibiotic allergy”,hereinafter referred to as “the guide”．According to the intervention,comparison and results of people with suspected antibiotic allergy,the guide systematically searched the literature of each question,and was formulated after reviewing the best evidence available through the evidence evaluation system．The guide elaborated on the suspected cross-allergy,quick-onset allergy and delayed-onset allergy,and selected antibiotics for reporting patients with antibiotic allergy．In this paper,12 key issues involved in the guidelines are interpreted in order to provide reference for clinical treatment of patients suspected of antibiotic allergy and benefit patients．
目的 观察低出生体重早产儿应用抗生素后肠道菌群的动态变化。方法 选取2018年6月—2019年7月在广州市第一人民医院住院的10名低出生体重早产儿,在出生时、出生后1~2周、出生后2~3周、出生后3~4周、出生后4~5周、出生后5~6周时分别收集粪便样本,通过16s高通量测序检测患儿粪便菌群变化并统计分析。结果 应用抗生素后的低出生体重早产儿肠道菌群α多样性(Shannon指数、Simpson指数、ACE指数和PD_whole_tree指数)下降(P均<0.05),肠道菌群结构在门、科、属水平均发生改变,其中Alistipes、Bacteroides、Lactobacillus、unidentified_Lachnospiraceae、unidentified_Ruminococcaceae、Alloprevotella、unidentified_Cyanobacteria、Bacillus、Stenotrophomonas和Acinetobacter菌属相对丰度减少(P均<0.05)。结论 低出生体重早产儿应用抗生素后肠道菌群多样性下降,肠道菌群结构发生改变,并在抗生素停用后仍持续,针对性补充益生菌或益生元可能有助于肠道菌群恢复稳态。
Objective To observe the dynamic changes of gut microbiota in premature infants with low birth weight after antibiotics therapy. Methods 10 low birth weight premature infants hospitalized in Guangzhou First People's Hospital from June 2018 to July 2019 were included. Fecal samples were collected at birth, 1~2 weeks after birth, 2~3 weeks after birth, 3~4 weeks after birth, 4~5 weeks after birth and 5~6 weeks after birth, respectively. The changes of fecal microbiota were detected and analyzed by 16s high-throughput sequencing. Results The α-diversity of gut microbiota (Shannon index, Simpson index, ACE index and PD_whole_tree index) in low birth weight preterm infants treated with antibiotics decreased (P<0.05). The structure of gut microbiota changed at phylum, family and genus levels, among which Alistipes, Bacteroides, Lactobacillus, unidentified_Lachnospiraceae, unidentified_Ruminococcaceae, Alloprevotella, unidentified_Cyanobacteria, Bacillus, Stenotrophomonas and Acinetobacter decreased (P<0.05). Conclusion The diversity of gut microbiota in low birth weight preterm infants decreased and the structure of gut microbiota changed after antibiotic therapy. Targeted supplementation of probiotics or prebiotics may contribute to the recovery of gut microbial homeostasis.
目的 调查分析中山市某三甲医院抗菌药物不良反应的发生和分布情况,为临床合理应用抗菌药物提供相关信息。方法 以中山市某三甲医院2013—2015年上报国家药品不良反应监测系统的528例抗菌药物的不良反应为考察对象,按照给药途径、不良反应严重程度、年龄、性别、药物种类、不良反应累及的系统-器官、不良反应发生时间进行分类、整理、归纳和总结。结果 累及系统-器官涉及皮肤及其附件、血液系统、神经系统、消化系统、泌尿系统等。其中皮肤及其附件损害、神经系统、胃肠道反应容易发现,消化系统、血液系统、泌尿系统、肝胆系统的反应具有隐匿性。结论 临床在使用抗菌药物时,既要关注其抗菌效应,也要高度警惕其不良反应的危害性。避免无指征用药,合理选用抗菌药物,科学地开展ADR 监测工作,确保临床安全、有效、合理用药。
Objective To investigate occurrence and distribution of adverse drug reaction ADR of antibiotic drugs in a hospital of Zhongshan, in order to provide relevant information for clinical rational use of antibacterial drugs. Methods We classified and analyzed 528 cases of adverse drug reaction of antibiotic drugs which was reported to National center for ADR Monitoring during 2013～2015, according to the administration route、the severity of ADRs、age、sex、types of drugs、the organs systems involved by ADRs, the time of ADRs occurrence. Results Adverse drug reaction of antibiotic drugs involved in skin and its appendix、hematological system、nervous system、digestion system、urinary system and so on. Among them skin and its appendix、nervous system and gastrointestinal reactions were easy to acquire, others were obscure and difficult to find. Conclusion When the clinical use of antibacterial drugs, should not only focus on its antibacterial effect, also need to keep high vigilance against the dangers of its adverse reactions. To ensure the clinical safety, effective and rational drug use, we need to avoid no indication of medicine, take rational use of antibiotic drugs,scientifically to carry out the ADR monitoring.
目的 了解中山市儿童社区获得性肺炎病原学特点及其与年龄、抗生素使用的相关性,为疾病诊断和抗生素合理使用提供参考依据。方法 对中山市妇幼保健院儿科住院部2016年1月—2016年4月收治的小儿社区获得性肺炎临床资料、入院前使用抗生素和病原学检测结果进行回顾性分析。结果 共有155例研究对象纳入研究,细菌检出95株,其中革兰氏阴性菌61株,革兰氏阳性菌34株。流感嗜血杆菌,金黄色葡萄球菌,肺炎链球菌,大肠埃希氏菌,副流感嗜血杆菌的占构成比前五位。支原体和衣原体现症感染率约7.7%～8.4%。RSV检出率达25.8%。年龄在3 a以上、入院前使用过抗生素者,革兰阳性菌检出率较低(P<0.05)。入院前使用过抗生素者,革兰阴性菌检出率较高,且使用4 d及以上者高于使用3 d及以下者(P<0.05)。结论 住院儿童CAP的治疗,应综合考虑病人的年龄、入院前的抗生素使用情况,结合当地CAP 的可能优势病原选择合适的治疗方案。
Objective To explore the etiological characteristics and factors of community-acquired pneumonia(CAP) in children in Zhongshan for providing reference for the diagnosis and rational use of antibiotics for CAP. Methods Retrospective analysis were applied on clinical data and etiology results of CAP in children admitted to the pediatric inpatient department of Maternal and Child Health Hospital in Zhongshan from January to April, 2016. Results 155 children were enrolled. The number of bacteria detected was 95, including 61 Gram-negative bacteria, 34 Gram-positive bacteria. Haemophilus influenzae, Staphylococcus aureus, Streptococcus pneumoniae, Escherichia coli, Haemophilus parainfluenzae accounted the top five. The recent infection rate of Mycoplasma and Chlamydia were from 7.7% to 8.4%. RSV detection rate was 25.8%.The Children who were over 3 years old, pre-use of antibiotics, associated with lower detection rate of Gram-positive bacteria (P<0.05). The Children who were the pre-use of antibiotics, associated with higher detection rate of Gram-negative bacteria, and the use of four days and more higher than three days or less(P<0.05). Conclusion For the treatment of CAP in children, the patient's age and pre-use history of antibiotics should be considered, combined with local common type of disease pathogens, to select the appropriate treatment.
