四川绵阳地区肺炎链球菌流行病学特征

目的了解四川绵阳地区肺炎链球菌的耐药情况,为临床合理用药及感染控制提供依据。方法收集我院2015年1月至2017年12月临床分离的718株肺炎链球菌,并对其药物敏感性检测结果进行分析。结果肺炎链球菌对红霉素和四环素的耐药率最高,均在95%以上;对左氧氟沙星、莫西沙星、泰利霉素、氯霉素的敏感性较高,均在89%以上;对青霉素、美罗培南、阿莫西林和头孢类抗生素的耐药率均在30%以上;未检出万古霉素和利奈唑胺耐药株。肺炎链球菌主要耐药模式为头孢曲松+红霉素+四环素+复方新诺明+美罗培南+青霉素+阿莫西林+头孢噻肟,占19.44%。2017年肺炎链球菌青霉素敏感株和不敏感菌株对美罗培南、阿莫西林、厄他培南、头孢噻肟、头孢曲松、氧氟沙星、复方新诺明和氯霉素的不敏感率比较差异有统计学意义(P0.05)。结论本地区肺炎链球菌对红霉素、四环素耐药率较高,不适用于肺炎链球菌感染的治疗;对青霉素、美罗培南、阿莫西林和头孢类抗生素不敏感率较高,应慎重用于经验治疗;对万古霉素、利奈唑胺和喹诺酮类药物敏感性较高,临床可合理使用。

Epidemiological characteristics of Streptococcus pneumonia isolates from adults and children in Mianyang, Sichuan

Abstract: Objective To learn the dynamic changes of drug resistance of Streptococcus pneumoniae (S. pneumoniae) in Mianyang, Sichuan and provide guidance for clinical treatment and control of S. pneumoniae infection. Methods The clinical isolates of S. pneumoniae from January 2015 to December 2017 in our hospital were collected, and the drug susceptibility test results were analyzed. Results These S. pneumoniae isolates had the highest resistance rates to Erythromycin (ERY) and Tetracycline (TCY), both over 95%. The sensitivity rates to Levofloxacin (LEV), Moxifloxacin (MFX), Telithromycin (TLT) and Chloramphenicol (CHL) were above 89%. The resistance rates to Penicillin (PEN), Meropenem (MEM), Amoxicillin (AMC) and Cephalosporin antibiotics were over 30%. No drug-resistant strains to Vancomycin (VAN) and Linezolid (LNZ) were detected. The main pattern of the resistances of S. pneumoniae was CRO+ERY+TCY+SXT+MEM+PEN+AMC+CTX (19.44%). Compared with Penicillin-susceptible S. pneumoniae, the resistance rates of non Penicillin-susceptible S. pneumoniae (2017) to MEM, AMC, Ertapenem (ETP), Cefotaxime (CTX), Ceftriaxone (CRO), Ofloxacin (OFX), Trimethoprim/Sulfamethoxazole (SXT) and CHL were statistically different (Ps<0.05). Conclusion ERY and TCY should not be used in treatment of S. pneumoniae infection because of the high resistance rates. PEN, MEM, AMC and cephalosporin antibiotics should be carefully used in empirical treatment due to the low sensitivity of the pathogen. VAN, LNZ and Quinolone antibiotics can be reasonably used in treatment of S. pneumoniae infection on account of the pathogen''s high sensitivity.