بررسي مقاومت آنتي بيوتيکي سویه های شیگلا جدا شده از بیماران مبتلا به گاستروانتريت مراجعه کننده به مرکز طبي کودکان طی سال های 95-90

بررسي مقاومت آنتي بيوتيکي سویه های شیگلا جدا شده از بیماران مبتلا به گاستروانتريت مراجعه کننده به مرکز طبي کودکان طی سال های 95-90

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:. اسهال یکی از بیماری های حاد دستگاه گوارش و شیگلا یکی از عوامل مهم اسهال کودکان در کشور ما می باشد. تنوع عوامل ایجاد کننده بیماری (گونه های شیگلا ) و بروز مقاومت دارویی ، انتخاب آنتی بیوتیک مناسب برای درمان شیگلوز را با مشکل مواجه می سازد. مطالعه حاضر با هدف  بررسي مقاومت آنتي بيوتيکي سویه های شیگلا جدا شده از بیماران مبتلا به گاستروانتريت مراجعه کننده به مرکز طبي کودکان طی سال های 95-90 صورت گرفت.
روش انجام مطالعه: این مطالعه گذشته نگر از فروردین 1390 تا فروردین 1395 در بیمارستان مرکز طبی کودکان انجام شد وتمام کودکان مبتلا به اسهال حاد وارد مطالعه شدند. شناسایی جدایه ها شیگلا توسط آزمایش های بیوشیمیایی و سرولوژیکی انجام شد. الگوی حساسیت آنتی بیوتیک این جدایه ها با روش دیسک دیفیوژن آگار طبق استانداردهای CLSI تعیین گردید.
نتایج: از میان 46795 نمونه مدفوع که از بیماران مبتلا به اسهال حاد جمع آوری شده بود، 573 نمونه (2/1%) بعنوان جنس شیگلا شناسایی شدند. 51% از بیماران (290 نفر) پسر و 49% از آنها (283) دختر  بودند . میانگین سنی بیماران 5 سال بود. بیشترین گونه جداسازی شده مربوط بود به شیگلا سونه ای (S. sonnei) با تعداد 335 (%4/58) بعد از آن شیگلا فلکسنری (S. flexneri با تعداد 229 (40%) ، شیگلا بوِِییدی (S. boydii) با تعداد 8 (%3/1) بود و فقط یک ایزوله (17/0%) بعنوان شیگلا دیسانتری S. dysenteriae ) )جدا شد.نتایج الگوی مقاومت نسبت به آنتی بیوتیک های مورد برسی بدین شرح بود: جنتامایسین 14% ، آمیکاسین 15%، ، سفاتاکسیم 37%، نالیدیکسیک اسید 51% ،آمپی سیلین 60% ، سیپروفلوکساسین 73%، تریمتوپریم سولفامتاکسازول 95%.
در بررسی شیگلاهای مقاوم به چند دارو مشخص شد 11 الگوی مقاومت دارویی مشاهده شده است.
نتیجه گیری: بیشترین فراوانی گونه مربوط به شیگلا سونه ای و بعد از آن شیگلا فلکسنری بود. آمپی سیلین و تریمتوپریم سولفامتاکسازول بالاترین الگوی مقاومت را نشان دادند و کمترین الگوی مقاومت نسبت به  سه آنتی بیوتیک سفاتاکسیم ،جنتامایسین و آمیکاسین بود.
كليد واژه ها: شیگلا،کودکان، مقاومت آنتی بیوتیکی
مشخصات دانشجو:
نام: زهراعرب یزدی         رشته تحصيلي:پزشکی     مقطع:دکترای عمومی                    گروه آموزشي:            پست الكترونيك دانشجو:za.yazdi@gmail.com
اساتيد راهنما و داور:
استاد راهنما :دکتر ستاره ممیشی،دکتر محمدتقی حقی آشتیانی
   اساتيد مشاور:دکتر بابک پوراکبری،دکتر شیما محمودی
   اساتيد داور:دکتر محمود خدابنده،دکتر محمدرضا عبدالصالحی
زمان دفاع :
   روز:سه شنبه     تاريخ :25/2/1397      ساعت:10صبح
مكان دفاع به آدرس:بلوار کشاورز،خیابان قریب،بیمارستان مرکز طبی کودکان،دفتر گروه کودکان
اطلاعات به زبان انگليسي
Title: Evaluation of Shigella Antimicrobial Drug Resistance in patients with gastroenteritis referred to Children medical center Hospital during 2011-2016
Abstract: Background: diarrhea is one of the acute gastrointestinal diseases and Shigellosis is an important cause of it in our country. Variety of its causing agents (Shigella strains) and occurrence of drug resistance have made troubles in selecting of appropriate antibiotics for the treatment of shigellosis. The study was carried out to determine the prevalence and pattern of antimicrobial resistance of Shigella species among pediatric patient with acute diarrhea in Children teaching hospital, Tehran, Iran during March 2011 to March 2016.
Patients and methods: This study included all acute diarrhea children who admitted to CMC hospital during March 2011 to March 2016. All isolates were detected as Shigella species by biochemical and serologic tests. Antibiotic sensitivity pattern of these isolates was confirmed by disk diffusion Method.
Results: Among all 46795 fecal samples from patients with acute diarrhea, 573 (1.2%) yielded Shigella. Of cases, 290 (51%) were boy and 283 (49%) were girl with a median age of 5 years .The most common Shigella isolates were S. sonnei (n=335 58%) followed by S. flexneri (n=229, 40%), S. boydii (n=8, 1.4%) and S. dysenteriae (n=1, 0.17%). Resistance pattern against various antimicrobials were as follows: gentamicin (14%), amikacin (15%), cefotaxime (37%), nalidixic acid (51%), ampicillin (60%) ciprofloxacin (73%) and trimethoprim- sulfamethoxazole (95%). Multidrug-resistant (MDR), (i.e. were resistant to three or more classes of antimicrobial agents) was detected into 11 distinct patterns.
 Conclusion: The most common isolates were S. Sonnei followed by S. flexneri. Ampicillin   and trimethoprim- sulfamethoxazole showed highest resistance pattern which low resistant was observed against cefotaxime, gentamicin and amikacin.
Keywords: : Antimicrobial resistance, Children, Shigella
 
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