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中国循证儿科杂志

中国循证儿科杂志 ›› 2010, Vol. 5 ›› Issue (5): 371-376.DOI:

• 论著 • 上一篇    下一篇

2006至2009年复旦大学附属儿科医院呼吸道感染患儿5种常见细菌构成比和耐药性分析

付盼1,何磊燕1,王爱敏,薛建昌,宋建明,王传清   

  1.  复旦大学附属儿科医院,上海201102
  • 收稿日期:2010-07-16 修回日期:2010-08-23 出版日期:2010-09-10 发布日期:2010-09-10
  • 通讯作者: 王传清

Drug resistance and proportion of five common pathogens isolated from children′s respiratory tract in Children′s Hospital of Fudan University from 2006 to 2009

FU Pan1, HE Lei-yan1, WANG Ai-min, XUE Jian-chang, SONG Jian-ming, WANG Chuan-qing   

  1. Children′s Hospital of Fudan University, Shanghai 201102, China;  1 Equal to contribution
  • Received:2010-07-16 Revised:2010-08-23 Online:2010-09-10 Published:2010-09-10
  • Contact: WANG Chuan-qing

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摘要：

目的 了解复旦大学附属儿科医院4年中呼吸道感染患儿呼吸道标本中化脓性链球菌、肺炎链球菌、金黄色葡萄球菌、流感嗜血杆菌和卡他莫拉菌耐药率变化。方法 以2006至2009年在复旦大学附属儿科医院诊断为呼吸道感染的患儿为研究对象，采集咽拭子或痰标本行细菌培养。细菌鉴定采用NCCLS/CLSI 2006至2009年标准及英国BSAC标准。采用琼脂扩散法（KB）对5种常见细菌进行药物敏感实验，结果参照CLSI 2006至2009年标准，肺炎链球菌青霉素药物敏感实验采用E-test检测。结果 2006至2009年呼吸道标本中共分离到细菌3 169株，其中化脓性链球菌1 225株、肺炎链球菌341株、金黄色葡萄球菌297株、流感嗜血杆菌248株、卡他莫拉菌237株。①化脓性链球菌在上呼吸道细菌中构成比为74.5％~78.8％，流感嗜血杆菌和卡他莫拉菌在上下呼吸道细菌中的构成比有逐年上升趋势（P<0.05）。②2006至2009年，化脓性链球菌对红霉素耐药率为86.8％～94.7％，未发现青霉素耐药株；青霉素不敏感肺炎链球菌比例为1.4％~20.8％,4年间差异有统计学意义（P=0.007），肺炎链球菌对红霉素耐药率为91.1％~97.9％；金黄色葡萄球菌对红霉素耐药率为50.0％~54.9％，耐甲氧西林金黄色葡萄球菌比例为7.7％~11.4％；上述3种细菌对万古霉素均敏感。流感嗜血杆菌和卡他莫拉菌β-内酰胺酶阳性率分别为17.0％~31.3％和83.1％~100％，流感嗜血杆菌对头孢呋辛耐药率较低，卡他莫拉菌对环丙沙星和阿莫西林/克拉维酸高度敏感。结论 化脓性链球菌和肺炎链球菌对青霉素高度敏感。化脓性链球菌、肺炎链球菌及金黄色葡萄球菌对红霉素高度耐药。产酶的流感嗜血杆菌对第2代头孢菌素高度敏感，卡他莫拉菌对喹诺酮类和酶抑制剂复合制剂高度敏感。

关键词: 儿童, 肺炎链球菌, 构成比, 呼吸道感染, 化脓性链球菌, 金黄色葡萄球菌, 卡他莫拉菌, 流感嗜血杆菌, 耐药性

Abstract:

Objective To determine the changes in antimicrobial resistance and proportion of Streptococcus pyogenes, Streptococcus pneumoniae, Staphylococcus aureus, Haemophilus influenzae and Moraxella catarrhalis isolated from the children with respiratory tract infections from 2006 to 2009. Methods Patients diagnosed as respiratory tract infection in Children′s Hospital of Fudan University from 2006 to 2009 were enrolled into the study and throat swabs or sputum specimens were collected to make bacteria culture. The susceptibility test was performed with KB method according to the criteria of Clinical and Laboratory Standards Institute (CLSI 2006-2009) . The resistance of Streptococcus pneumoniae to penicillin was assayed with E-test according to the criteria of CLSI 2009. Results From 2006 to 2009, a total of 1 225 Streptococcus pyogenes, 341 Streptococcus pneumoniae,297 Staphylococcus aureus, 248 Haemophilus influenza and 237 Moraxella catarrhalis isolates were collected from respiratory tract samples of out-patients and in-patients of Children′s Hospital of Fudan University. Streptococcus pyogenes was still the prime pathogen in the upper respiratory tract, and its proportion was ranged from 74.5％ to 78.8％ from 2006 to 2009. The proportion of Haemophilus influenzae and Moraxella catarrhalis increased anually both in upper and lower respiratory tract. The drug resistant monitoring showed that erythromycin resistance rates of Streptococcus pyogenes varied from 86.8％-94.7％,and Streptococcus pyogenes isolates resistant to penicillin were not found. About 1.4%-20.8% of Streptococcus pneumoniae were resistant (PRSP) or intermediate (PISP) to penicillin ,and the resistant rates kept increasing (P=0.007) from 2006 to 2009. 91.1%-97.9% of Streptococcus pneumoniae isolates were resistant to erythromycin. Staphylococcus aureus resistant to erythromycin was ranged from 50.0% to 54.9%, and methicillin-resistant Staphylococcus aureus(MRSA) was ranged from 7.7% to 11.4%. Streptococcus pyogenes, Streptococcus pneumoniae and Staphylococcus aureus were all sensitive to vancomycin. The β-lactamase positivities of Haemophilus influenza and Moraxella catarrhalis isolates were 17.0％-31.3％ and 83.1%-100% respectively, both Haemophilus influenzae and Moraxella catarrhalis were highly susceptible to the second and third generation cephalosporins, the enzyme inhibitor complex and the quinolones. Conclusions Penicillin was still the first choice to treat the infection caused by Streptococcus pyogenes and Streptococcus pneumoniae in children. Streptococcus pyogenes, Streptococcus pneumoniae and Staphylococcus aureus were still highly resistant to erythromycin. Both second and third generation cephalosporins showed good therapeutic effects against β-lactamase positive Haemophilus influenzae and Moraxella catarrhalis.

Key words: Children, Constituent ratio, Drug resistence, Haemophilus influenzae, Moraxella catarrhalis, Respiratory tract infection, Staphylococcus aureus, Streptococcus pneumoniae, Streptococcus pyogenens