侵袭性和非侵袭性肺炎链球菌耐药率的比较分析

目的研究侵袭性和非侵袭性肺炎链球菌的耐药谱的差异，指导合理应用抗生素及感染管理。方法回顾性统计分析2009至2011年来天台县人民医院就诊患者分离肺炎链球菌的标本来源及耐药性，比较侵袭性和非侵袭性肺炎链球菌耐药率之间的差异。结果共分离出肺炎链球菌642株，痰液中分离出584株，非痰液中分离出58株，其中血液中分离出32株，脑脊液中分离出20株，其他分离出6株，所有肺炎链球菌对万古霉素和利奈唑胺均敏感，对青霉素、红霉素、克林霉素、四环素及复方新诺明耐药严重，对左氧氟沙星、氯霉素比较敏感；侵袭性分离株对青霉素、红霉素、克林霉素、左氧氟沙星、四环素及氯霉素的耐药率显著高于非侵袭性肺炎链球菌。结论该院分离的肺炎链球菌主要来自痰液标本，耐青霉素肺炎链球菌的检出率高，大环内酯类耐药严重，存在一定比例的侵袭性感染，非侵袭菌株与侵袭性菌株耐药谱之间存在一定差异，临床治疗应该区别对待，系统的监测细菌耐药性，合理选择抗菌药物。

Comparsion of antimicrobial-resistant profiles of Streptococcus pneumoniae from invasive and non-invasive infections

Objective To investigate the distribution and drug resistance of Streptococcus pneumoniae isolated from patients with invasive and non-invasive infections for reasonable application of antibiotics and control infection.Method Bacteria isolated from patients with invasive and non-invasive infections in our hospital from 2009 to 2010 were identified,and their sensitivity to antibiotics were tested and analyzed.The resistance difference between the invasive and non-invasive infections strains was compared.Result A total 642 strains were isolated,of which 584 strains from sputa and 58 strains from non-sputum specimens,in cluding 32 strains from blood,20 strains from cerebrospinal fluid and 6 strains from others.All strains were sensitive to vancomycin and linezolid.The resistance to penicillin,erythromycin,clindamycin,tetracycline and SMZ-TMP was serious,but the strains were more sensitive to levofloxacin and chloramphenicol.The resistance rates of invasive isolates to penicillin,erythromycin,clindamycin,levofloxacin,tetracycline and chloramphenicol were significantly higher than those of non-invasive strains.Conclusion Streptococcus pneumoniae isolates in our hospital are mainly from sputum specimens,the isolating rate of PNSP is higher and the drug resistance rates to macrolides are serious.There also exists a certain proportion of invasive infections.There are certain differences of the resistant rates between non-invasive and invasive strains.So we shall use different strategy in treatment of non-invasive and invasive infections.A systematic monitoring of drug resistance is the prerequisite for rational use of antibiotics.