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中国循证儿科杂志

中国循证儿科杂志 ›› 2016, Vol. 11 ›› Issue (4): 241-246.

• 论著 •    下一篇

中国西部单中心二级医院呼吸道感染住院患儿鼻咽部肺炎链球菌携带及其血清型和耐药性的横断面调查

陈长会1,4,史伟2,4,彭拥军1,熊维1,袁林2,高薇2,程小平3,姚开虎2   

  1. 1 重庆市酉阳土家族苗族自治县人民医院，重庆医科大学附属第一医院酉阳医院儿科重庆，409899；2 首都医科大学附属北京儿童医院、北京市儿科研究所，儿科学国家重点学科，教育部儿科重大疾病研究重点实验室，国家呼吸系统疾病临床医学研究中心，儿童呼吸道感染性疾病研究北京市重点实验室北京，100045；3 重庆市酉阳土家族苗族自治县人民医院，重庆医科大学附属第一医院酉阳医院检验科重庆，409899；4 共同第一作者
  • 收稿日期:2016-06-25 修回日期:2016-08-29 出版日期:2016-08-25 发布日期:2016-08-25
  • 通讯作者: 程小平，姚开虎

Nasopharyngeal carriage rate, serotype distribution and antibiotic resistance pattern of Streptococcus pneumoniae isolates collected from hospitalized children with respiratory tract infections in a single-center grade two hospital in western of China: a cross-sectional study

CHEN Chang-hui1,4，SHI Wei2,4,PENG Yong-jun1,XIONG Wei1,YUAN Lin2,GAO Wei2,CHENG Xiao-ping3,YAO Kai-hu2   

  1. 1 Department of Pediatrics, Youyang Hospital, The First Affiliated Hospital of Chongqing Medical University; People′s Hospital of Chongqing Youyang County, Chongqing 409899; 2 Key Laboratory of Major Diseases in Children, Ministry of Education, National Key Discipline of Pediatrics (Capital Medical University), National Clinical Research Center for Respiratory Diseases，Beijing Key Laboratory of Pediatric Respiratory Infection Diseases, Beijing Pediatric Research Institute, Beijing Children′s Hospital affiliated to Capital Medical University, Beijing 100045; 3 Department of Clinical Laboratory, Youyang Hospital, The First Affiliated Hospital of Chongqing Medical University; People′s Hospital of Chongqing Youyang County, Chongqing 409899; 4 co-first authors
  • Received:2016-06-25 Revised:2016-08-29 Online:2016-08-25 Published:2016-08-25
  • Contact: CHENG Yi-ping,YAO Kai-hu

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摘要：

目的 了解不发达地区二级医院呼吸道感染住院患儿鼻咽部肺炎链球菌的携带情况及分离株的血清型分布和耐药性特征。方法 采集重庆市酉阳土家族苗族自治县人民医院（简称酉阳医院）2015年1~12月呼吸道感染住院患儿鼻咽拭子标本，培养并分离肺炎链球菌，采用荚膜肿胀实验对分离株进行血清分型。随机选取50%的肺炎链球菌分离株以E-test法和纸片扩散法对16种常见抗菌药物检测其敏感性。结果 研究期间共采集鼻咽拭子标本1 054份，分离出肺炎链球菌267株，分离率为25.3%。≤5岁儿童分离率较高，冬春季分离率较高。267株肺炎链球菌分离株中最常见的血清型为19F型（47株，17.6%），其次为6A（35株，13.1%）、14（31株，11.6%）、19A（28株，10.5%）、23F（28株，10.5%）和6B型（25株，9.4%）。13价肺炎链球菌结合疫苗（PCV13）的覆盖率为73.8%（197/267）。136株肺炎链球菌行抗生素药敏试验，所有菌株对头孢曲松、万古霉素和左氧氟沙星敏感，对利奈唑胺、亚胺培南和泰利霉素的敏感率较高，分别为96.3%、87.5%和84.5%；静脉青霉素的敏感率为100%，口服青霉素的敏感率为16.9%。99.3%（135/136)的分离株对红霉素和阿奇霉素耐药。PCV13覆盖株对口服青霉素、头孢吡肟、头孢呋辛和亚胺培南的不敏感率明显高于非PCV13覆盖株（P<0.01）。19A型菌株对口服青霉素、头孢吡肟不敏感率为100%。结论 酉阳医院呼吸道感染住院患儿鼻咽部肺炎链球菌的分离率为25.3%，常见血清型为19F、6A、14、19A、23F和6B，PCV 13覆盖率较高，且PCV13覆盖株对口服青霉素、头孢吡肟、头孢呋辛和亚胺培南的不敏感率明显高于非PCV13覆盖株。

Abstract:

Objective To investigate the status of nasopharyngeal carriage rate, serotype distribution and antibiotic resistance pattern of Streptococcus pneumoniae isolates collected from children with respiratory tract infections inpatiented in Youyang county.Methods The nasopharyngeal swab was collected from children with respiratory tract infections inpatiented in People′s Hospital of Chongqing Youyang County from January to December in 2015. The serotype was determined by Quellung reaction, and the antibiotic susceptibility was tested by E-test method and disc diffusion.Results The nasopharyngeal carriage rate of Streptococcus pneumoniae was 25.3% (267/1054), major in winter and spring among children younger than 5 years old. Serotype 19F(47, 17.6%), 6A(35, 13.1%), 14(31, 11.6%), 19A(28, 10.5%), 23F(28, 10.5%) and 6B(25, 9.4%) were the common serotypes, and the coverage rate of 13-pneumococcal conjugate vaccine (PCV13) was 73.8%(197/267). All of the isolates were sensitive to ceftriaxone, vancomycin and levofloxacin. The sensitive rates to linezolid, imipenem and telithromycin were 96.3%, 87.5% and 84.5%, respectively. All of the isolates were sensitive to penicillin using the parenteral breakpoints, but the sensitive rate was just 16.9% according to the oral breakpoints. 99.3% (135/136) of the isolates were resistant to erythromycin and azithromycin. The non-suscepibility rates to oral penicillin, cefepime, cefuroxime and imipenem were higher in PCV13 isolates than non-PCV13 isolates (P<0.01). Isolates of serotype 19A were more resistant than the other serotype isolates.Conclusion The nasopharyngeal carriage rate of Streptococcus pneumoniae was 25.3%, the common serotypes were 19F, 6A, 14, 19A, 23F and 6B. PCV13 coverage rate was high, and the non-suscepibility rates to oral penicillin, cefepime, cefuroxime and imipenem were higher in PCV13 isolates than non-PCV13 isolates.