Study On Antibiotic Use In Children And Bacterial Resistance Dependablity In Changchun

The ntibiotic se have contributed to treat infectious iseases,however,along with the antibiotic abuse,more and drug-resistance bacterialhave been increasingly and quickly disseminated ,made great difficulty to treatdiseases, seriously threaten mankind health.It caused situation of the antibioticcrisis on medical science at present. The reasons that bacteria are resistant toantibiotics are lied in two sides. The first one is that the genes encodingresistance is located on the chromosome,the other is mediated by the drugresistance plasmids.Plasmids are circular DNA molecules that contain ownorigins of replication, therefore, replication separately from the mainchromosome. Within pediatrics infectious diseases,it is serious problem thatpathogenic bacteria resist antibiotic.It has significance to guide reasonable useof antibiotic to understand the use of antibiotic in pediatrics, to investigateclinical isolated bacteria distribution and drug-resistance characteristic, toquickly detect drug-resistance bacterial. The IIIA hospital in changchun is ageneral hospital in changchun, the more paediatrics patient, the more antibioticuse, moreover, majority new drug are firstly used. It is representation that thestatus of antibiotic use and bacteria distribution and the bacterial resistance. Inorder to carry information to reasonable use of antibiotic the study onantibiotic use in children and bacterial resistance dependablity in the hospitalhas been developed .ObjectiveTo investigate the use of antibiotics in pediatrics patients in chang chun,To derect distribution and antibiotic resistance of main pathogens forreasonable clinical use of antibiotic drugs. In this study, methicillin-resistant(mecA) gene and erythromycin resistance [erm(C)] genes were investigated inStaphylococcus aureus and coagulase negative staphylococci (CNS) , TEM andSHV genes were detected in E. coli and K. pneumonia,to study theepidemiology of drug-resistant genes of productive enzyme in bacteria.Method1. One thousand two hundred cases of infectious disease retrospectivelyinvestigated the use of antibiotic from January 2003 to November 2005 andlook up the illness record relevant to antibiotic use , enter questionnaire andnineteen kinds of antibiotics which used were analyzed.2. All the bacteria were isolated from blood, sputum , pus,urine, genitalduct excreta, discharge of eye and throat swab of children in hospital patientsfrom December, 2003 to November, 2005 in the hospital,according to themethod in《clinical medicine test handbook》.3. All the bacterial isolations from Bacterial susceptibility testing wascarried out with Kirby—Bauey method. Tests were performed according to theguidelines of NCCLS.4. Methicillin-resistant (mecA) gene and erythromycin resistance [erm(C)]genes were investigated in Staphylococcus aureus and coagulase-negativestaphylococci (CNS) and blaTEM and blaSHV genes were detected in E. coliand K. pneumonia by polymerase chain reaction (PCR).Result1.The use rate of antibiotic in pediatric department was 100% ( includingsingle and multiple use). All antibiotic including six groups and thirteen kinds.The main antibiotics were β-lactamase inhibitor(51.5 %), penicillins(42.0%),cephem antibiotics(36.0%), macrolides antibiotic (22.0%).Theuse rate of antibiotic kinds were ceftezole(29.5%),amoxicillin—clavulanicacid(25.8%), cefoperazone—sulbactam(18.7%),azithromycin(17.0%),penicilin(16.6%),oxacillin(16.0%),piperacillin—sulbactam(7.0%),cefuroxime sodium(6.5%),amoxicillin(6.0%),erythromycin(5.0%)。Single use was 75.0%,multiple use was is 25.0%, macrolides antibioticassociate with amoxicillin—clavulanic acid at most,then macrolides antibioticassociate with cefoperazone —sulbactam.2. Altogether 818 strains of pathogens were isolated from one thousandtwo hundred major samples. Gram positive coccus, gram negative accountedfor 48. 0 % , 52.0 % . The most common pathogens were CNS(18.6%) ,E. coli(14.5%) , S. aureus(12.6%),K.pneumoniae(10.9%), S.pneumoniae(6.8%), P.aeruginosa(6.6%) , B.catarrhalis(5.5%) and Enterococus (5.4%).The mostcommon pathogens in blood specimens were CNS ,S. aureus, P.aeruginose,and E.coli .The most common pathogens in sputum were CNS, E.coli,K.pneumonia and P.aeruginosa.The most common pathogens in pus were CNS,S.aureus, beta-hemolytic streptococci and E. coli. The most commonpathogens in nasopharyngeal swab were CNS, S.aureus, S.pneumoniae, E.coli ,K.pneumoniae, B.catarrhalis and Enterococus.3.All bacteria isolated exhibit a high resistance against Penicillins andCephalosporins . The drug resistance rate of Gram-positive bacteria againstpenicillin were more than 51.0%,The drug resistance rate of SA ,CNS ,Enterococus and S.pneumonic against penicillin and erythromycin were morethan 85.0% and 73.0% respectively. The isolations of methicillin-resistancestaphylococcus aureus (MRSA) and MRCNS were 46.3 %, 62.0%. Theantibiotic remaining the most active against Gram-positive bacteria wasVancomycin, Rifampicin. The drug resistance rate of Gram-negative bacteriaagainst Ampicillin was more than 83.0%.The drug resistance rate againstPiperacillin, Cefoperazone/Sulbactam,Cefutoxime,Cefazolin and Ceftriaxonewere more than 55.0% ,the rate against Gentamicin and SMZ/TMP were morethan 50.0% , the rate against Cefaclor, Cefoperazone and Tobrmycin weremore than 40%,the rate against Chloramphenicol and Aztreonam were morethan 32.0%. The susceptibility of Gram-negative bacteria was Imipenem( <8.0% ,except P.aeruginosa),much higher than those to ceftadime andAmikacin (<32. 0 %). The isolations rate of multiple resistance Gram-negativebacteria was73.0%.The isolations rate of E.coli and K.pneumoniae produdct ESBLs were58.0%,69.0%。4.Detection rates of mecA in CNS and SA were 48.7%,38.8%. Detectionrates of mecA in MRCNS and MRSA were 79.6%, 83.3%. Regarding theerythromycin resistance genes, detection rates of erm(C) genes in MRCNS andMRSA were 81.1%, 82.5%.PCR analysis of Aztreonam resistant E. coliisolates detected blaTEM and blaSHV genes in 57.1% and 3.4%,theassociation of both genes was 2.5%.Aztreonam resistant K.pneumoniae detected blaTEM and blaSHV genesin 46.1% and 68.5%, the association of both genes was 25.8%.Conclusion1. There is the abuse use of antibiotic in this department, the selectivepressure affect the resistance of bacteria .In order to abase or prevent theincreasing resistance of bacteria , need to reasonable use antibiotic and controlof the abuse use.2.CNS,E. coli, S. aureus,K.pneumoniae,S.pneumoniae, P. aeruginosaand B.catarrhalis were majority pathogenic bacteria isolated from pediatrics inChang Chun.3. All bacteria isolated exhibit a high resistance to Penicillins andCephalosporins, Multi-drug resistance of bacteria is a serious problem inpediatrics. Imipenem remains highly active against Gram-negative bacteria. Itis very important to monitor the distribution of bacteria and their resistance toantibiotics in pediatric patients, which is helpful to select antibiotic correctly.4. PCR is a suitable tool for initial rapid screening of antibiotic resistancegenes in bacteria.