【摘要】 目的了解北京市A组链球菌(GAS)感染儿童的临床症状,分析GAS分离株对抗菌药物的耐药性,为GAS的诊断和用药提供依据。方法将2015年5月-2018年7月在北京市36家医院经实验室分离培养确诊的106例儿童GAS菌株为研究对象,收录感染儿童的临床症状,采用VITEK-2全自动微生物分析系统和GPS-67药敏卡测定分离株对抗菌药物的最低抑菌浓度,依据CLSI 2015年的M100-S22判定标准判断其对抗菌药物的敏感性。结果临床诊断为猩红热或咽部感染且GAS阳性的儿童均出现体温升高,58.42%的最高体温超过38.5℃,55.45%有咽峡炎、68.32%有扁桃体炎、50.50%有口腔黏膜充血的症状。咽峡炎、扁桃体炎和口腔黏膜充血在临床诊断为猩红热和咽部感染的儿童间差异无统计学意义(P>0.05)。分离的106株A组链球菌对克林霉素、红霉素、四环素的耐药率分别为100.00%、99.06%和97.17%,临床诊断为猩红热和咽部感染的儿童所分离的菌株对红霉素和四环素的耐药性差异无统计学意义(P>0.05)。结论咽峡炎、扁桃体炎和口腔黏膜充血不能用于临床中猩红热和咽部感染儿童的鉴别诊断,青霉素、氨苄青霉素、左旋氧氟沙星、链阳霉素、利奈唑铵、替加环素均可用于治疗GAS感染,而克林霉素、红霉素、四环素则谨慎使用。更多还原

【Abstract】 Objective To understand the clinical symptoms of GAS-infected children and to analyze the sensibility to antibacterial agents in Beijing,so as to provide evidence for the diagnosis and drug use of GAS. Methods The GAS strains of 106 children diagnosed in 36 hospitals in Beijing during 2015 May to July 2018 were isolated and cultured,and the clinical symptoms of the infected children were recorded. The minimal inhibitory concentrations( MIC) of the isolates was determined by VITEK-2 automated microbial analysis system and GPS-67 Minka drug susceptibility card. The sensitivity of the isolates was judged according to the M100-S22 criteria of CLSI in 2015. Results Children with a clinical diagnosis of scarlet fever or pharyngeal infection and GAS positive showed elevated body temperature,with 58. 42% having a maximum temperature over38. 5 ℃,55. 45% having angina,68. 32% having tonsillitis and 50. 50% having congestion oral mucosa. There were no statistically differences in angina,tonsillitis,and congestion oral mucosa between children with a clinical diagnosis of scarlet fever and pharyngeal infection( P>0. 05). The resistance rates to clindamycin,erythromycin and tetracycline were 100. 00%,99. 06% and 97. 17%,respectively. There was no significant difference in resistance to erythromycin and tetracycline in children with clinical diagnosis of scarlet fever and pharyngeal infection( P>0. 05). Conclusions Angina,tonsillitis and congestion oral mucosa cannot be used in differential diagnosis between scarlet fever and pharyngeal infection in children. Penicillin,ampicillin,levofloxacin,streptozotocin,linezolid,and tigecycline can be used in the treatment of GAS infections,while clindamycin,erythromycin,and tetracycline should be used cautiously.更多还原