甲型副伤寒89例临床表现与药敏分析(1)
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[摘要] 目的:通过对甲型副伤寒的临床特点及药敏分析,为临床诊断及合理选择抗生素提供参考。方法:对89例甲型副伤寒沙门菌血液及骨髓培养阳性患者的临床表现及药敏及临床疗效进行统计学分析。结果:89例患者均有发热,血白细胞正常或减少,嗜酸粒细胞减少,50%有转氨酶升高、对多种抗生素高度敏感,尤其喹诺酮类、氨基糖苷类、头孢三代(头孢他啶、头孢曲松、头孢噻肟)及氯霉素敏感率大于90%,其中,左氧氟沙星、阿米卡星、庆大霉素、头孢他啶敏感率为100%,平均疗程10 d,平均退热时间5.4 d。结论:甲型副伤寒以发热为主,对多种药物敏感,考虑药物副作用、疗效、费用等因素,建议首选喹诺酮类,次选头孢类,合并肺部感染者可二者联用。
[关键词] 甲型副伤寒;临床表现;药敏试验;临床疗效
[中图分类号] R378.2+4[文献标识码]A [文章编号]1673-7210(2009)08(a)-036-02
Analysis of clinical features and drug sensitivity of 89 cases of paratyphoid A LI Wenquan, KANG Tao
(Department of Infectious Disease, the Second People's Hospital of Yibin City, Yibin 644000, China)
[Abstract] Objective: To offer a guidance for clinical diagnosis and reasonable application of antibiotics by summarizing clinical presentations and drug sensitivity of paratyphoid A. Methods: Clinical features, laboratory characteristics and therapeutic efficacy of 89 cases with paratyphoid A were admitted in this clinical analysis. Results: The clinical manifestations of paratyphoid A included: fever, normal or count decline of white blood cell and blood eosinophilic granulocyte, half of the patients had rising aminotransferase and were sensitive to diverse antibiotics, especially to fluoquinolones, aminoglycoside, the third generation of cephalosporins (Ceftazidime, Cefotaxim) and Chloromycetin, the sensitive rates of them were higher than 90%, among them, the sensitive rates of Lavo-Ofloxacin, Butikacin, Gentamicin and Ceftazidime were 100%. Average course of treatment and defervesce was 10 and 5.4 days respectively. Conclusion: Patients with paratyphoid A show fever, sensitive to diverse antibiotics. Considering drug side-effect, healing effect and cost, fluoroquinolones is first choice and cephalo-type is second choice, both of them can combine when complicated with pneumonia.
[Key words] Paratyphoid fever A; Clinical feature; Drug sensitive test; Clinical efficacy
近10年来我市伤寒发病明显减少,而甲型副伤寒发病率增加,就我院2005年5月～2006年6月收治的经血液、骨髓培养确诊的甲型副伤寒89例。现将其临床表现、药敏试验及疗效观察结果分析报道如下:
1 资料与方法
1.1 一般资料
89例全是住院患者,其中,男性53例,女性36例;年龄18～68岁,平均43岁。所有病例均经血液或骨髓培养确诊,经血液培养的有87例,有2例经骨髓培养确诊。院外未使用抗生素12例。
1.2 临床表现
所有病例均有不同程度的发热,其中,表情淡漠31例,肝大29例,脾大34例,腹泻12例,便血2例,咳嗽8例。
1.3 实验室检查
血分析白细胞<4.0×109/L 51例(57.3%),嗜酸粒细胞40 U/L 49例(55.1%),心肌酶谱升高11例(12.4%)。
1.4并发症发生情况
见表1。
表1 并发症发生情况
2 药敏分析
2.1 细菌来源
89株甲型副伤寒均来自血或骨髓培养。
2.2 抗菌药物
环丙沙星、氧氟沙星、左氧氟沙星、庆大霉素、阿米卡星、氨苄青霉素、头孢他啶、头孢曲松、头孢噻肟、氯霉素 ......
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