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目的分析甲型副伤寒临床特征,对分离株进行抗生素敏感性实验,为早期诊断、合理用药供依据。方法对玉溪市第一人民医院2011—2012年疑似患者531例采血进行双相血培养,分离菌株用纸片K-B扩散法行抗生素敏感性实验;对确诊病例进行回顾性调查。结果血培养分离到甲型副伤寒菌株125株(23.5%);125例患者主要表现为发热(100.0%,弛张热多见)、食欲不振(77.6%)、头痛眩晕(48.8%)、腹胀(40.0%)、腹泻(37.6%)等,并发症少见;实验室检验主要为嗜酸粒细胞减少(76.8%)和肝功异常(71.2%);抗生素敏感性检测,对氨苄西林、阿莫西林、头孢噻肟、四环素、庆大霉素和复方新诺明100.0%敏感;对头孢噻吩98.4%敏感,中介率1.6%;对环丙沙星60.8%敏感,中介率39.2%;对萘啶酸和利福平100.0%耐药。结论玉溪市甲型副伤寒病例临床表现不典型,实验室检验以嗜酸粒细胞减少和肝功异常为主,及时诊治尤为重要。宜采用三代头孢菌素类治疗。
Objective To analyze the clinical features of Paratyphoid A, and to conduct antibiotic susceptibility tests on the isolates for early diagnosis and rational drug use. Methods Biphasic blood cultures were collected from 531 cases of suspected patients in Yixian First People’s Hospital from 2011 to 2012. Antibiotic susceptibility tests were performed on K-B diffusion strains isolated from strains. The confirmed cases were retrospectively investigated. Results 125 strains (23.5%) of Paratyphoid A strains were isolated from blood culture. 125 cases showed fever (100.0%), loss of appetite (77.6%), headache and dizziness (48.8%), bloating (40.0%) and diarrhea (37.6%). The complication was rare. Laboratory tests mainly included eosinophilia (76.8%) and abnormal liver function (71.2%). Xilin, cefotaxime, tetracycline, gentamicin and cotrimoxazole 100.0% sensitive to cephalothin 98.4% sensitive, mediated rate of 1.6%; ciprofloxacin 60.8% sensitive, mediated rate of 39.2%; naphthyridine Acid and rifampicin 100.0% resistant. Conclusion The clinical manifestations of paratyphoid A in Yuxi City are not typical. Laboratory tests mainly include eosinophilia and abnormal liver function, which are particularly important in diagnosis and treatment. Should adopt the third generation cephalosporins treatment.