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1986年1月至4月期间在本院产科婴儿室及儿科新生儿病室暴发流行60例致病性大肠杆菌(EPEC)肠炎,均为同一血清型O_(126):B_(16)。男33例,女27例;发病>4天者占83.4%。全部为人工喂养儿。主要症状为腹泻、发热、脱水、黄疸、反应差、腹胀等,并发症以高胆红素血症(28.3%)、酸中毒(20%)为多,此外,低钠血症3例,核黄疸2例,肠穿孔及新生儿坏死性小肠结肠炎(NEC)各1例。本组重症患儿占63.3%。病情较其他报告为重。本组用琼脂稀释法测定60株EPECO_(126):B_(16)对五种常用抗生素的最低抑菌浓度(MIC)。新霉素抑菌作用最强,MIC为2μg/ml,卡那霉素为32μg/ml,多粘菌素E 及庆大霉素均为64μg/ml。但当16μg/ml 时多粘菌素E 耐药菌株仅5%而庆大霉素却高达98.3%。氨基苄青霉素MIC>128μg/ml,无抑菌作用。本组治愈50例(83.3%),好转9例(15%)、死亡1例为1300g 早产儿死于NEC,病死率为1.7%。本文在讨论阻断流行的措施中体会到:(1)彻底单间隔离、专人护理及诊治;(2)接触者预防用药;(3)工作人员认真洗手及尿布消毒;(4)抱母奶;(5)必要时关闭新生儿病室是重要环节。
Between January and April 1986, 60 pathogenic E.coli (EPEC) enteritis were observed in obstetric and neonatal wards in our hospital, all of which had the same serotype O_ (126): B_ (16). There were 33 males and 27 females, accounting for 83.4% of the patients with onset> 4 days. All artificial feeding children. The main symptoms are diarrhea, fever, dehydration, jaundice, poor response, abdominal distension, complications with hyperbilirubinemia (28.3%), acidosis (20%) as more than three cases of hyponatremia, nuclear 2 cases of jaundice, 1 case of intestinal perforation and neonatal necrotizing enterocolitis (NEC). The group of critically ill children accounted for 63.3%. The condition is heavier than the other reports. In this study, the minimum inhibitory concentration (MIC) of 60 EPECO 126: B 16 antibiotics against five commonly used antibiotics was determined by agar dilution method. Neomycin had the strongest bacteriostasis with MIC of 2μg / ml, kanamycin of 32μg / ml, polymyxin E and gentamicin of 64μg / ml. However, the polymyxin E-resistant strain was only 5% at 16 μg / ml and gentamicin was as high as 98.3%. Ampicillin MIC> 128μg / ml, no antibacterial effect. This group cured 50 cases (83.3%), improved in 9 cases (15%), 1 case died of 1300g premature children died of NEC, the mortality rate was 1.7%. This article discusses the measures to block the epidemic in the realization of: (1) a thorough isolation between single, specialist care and diagnosis and treatment; (2) the prevention of contact medication; (3) cleansing staff and diapers disinfection; (4) (5) Neonatal ward closure is an important link when necessary.