儿童肺炎链球菌和流感嗜血杆菌耐药及感染特征分析

目的 了解儿童呼吸道感染肺炎链球菌(Streptococcus pneumonia,SP)和流感嗜血杆菌(Haemophilus influenzae,Hi)的分布特征、耐药情况,及耐药菌抗生素间的相互影响,以更合理地指导临床用药.方法 对2009-2010年临床呼吸道感染患儿进行痰、咽拭子或肺泡灌洗液培养分离Hi和SP.因子需求试验鉴定Hi,头孢硝噻酚法检测β-内酰胺酶；奥普托辛和胆汁溶菌试验确认SP.两菌均采用K-B法检测常用对抗生素的耐药性.结果 收集SP 495株,Hi 515株,多见于3岁以下儿童,以呼吸科分离率最高.SP对红霉素、四环素、阿奇霉素、复方新诺明的耐药率分别为98.4％、66.1％、98％和81.6％,其对青霉素敏感性仅为9.5％.Hi有42.7％产生β-内酰胺酶,Hi对氯霉素、复方新诺明、氨苄青霉素、阿奇霉素的耐药率分别为22.1％、21.6％、36.7％和62.7％.与青霉素敏感SP和β-内酰胺酶阴性Hi相比,耐药SP和阳性Hi更易对氯霉素、四环素和复方新诺明耐药.结论 SP和Hi以婴幼儿为主,多见于呼吸科.其耐药情况严峻,青霉素耐药和产β-内酰胺酶菌株会诱导其他抗生素耐药,引发多重耐药.合理使用抗生素以及对两菌的耐药监测应引起高度重视.

Drug-resistance and infectious characteristics of Streptococcus pneumonia and Haemophilus influenzae in children

Objective To study the distribution and antibiotic resistance of Streptococcus pneumonia(SP) and Haemophilus influenzae(Hi) from pediatric respiratory tract infection,and the interaction between drug-resistant strains and antibiotics,so as to guide rational antibacterial therapy.Methods SP and Hi were isolated from sputum,pharyngeal swab or bronchoalveolar lavage fluid specimens of pediatric respiratory tract infection during 2009 to 2010.Hi was identified by V and X factors′ requirement test,and β-lactamase was tested by Cephalosporins tanner thiaphenol method.SP was identified by optochin and bile lysozyme.The drug sensitivity of all strains were determined by Kirby-Bauer method.Results 495 strains of SP and 515 strains of Hi were isolated,most of which were from children under 3 years old.The highest isolation rate were found in Pneumology Department.The resistance rates of SP to erythrocin,tetracycline,Azithromycin and cotrimoxazole were 98.4%,66.1%,98% and 81.6%,respectively.Only 9.5% of SP were sensitive to penicillin.42.7% of β-lactamase producing strains were found in Hi.The resistance rates of Hi to chloramphenicol,cotrimoxazole,ampicillin and azithromycin were 22.1%,21.6%,36.7% and 62.7%,respectively.Compared to penicillin-sensitive SP and β-lactams negative Hi,the resistant SP and positive Hi were more prone to be resistant to chloramphenicol,cotrimoxazole and tetracycline.Conclusion SP and Hi usually appear in children under 3 years old in Pneumology Department.The drug-resistances of both bacteria are severe.Penicillin-resistant and β-lactams positive strains are prone to induce other antibiotic resistance.Rational use of antibiotics and surveillance should be taken into account.