142例儿童感染肺炎链球菌的耐药性分析

目的分析儿科病房的肺炎链球菌的主要分布情况以及耐药现状。方法收集宁波市妇女儿童医院儿科病房2010年1月1日至2012年12月31日临床分离的142株肺炎链球菌，采用法国生物梅里埃公司的VITEK-60型全自动微生物分析仪进行菌株鉴定。采用纸片扩散法（K—B法）做药敏试验，用参考菌株做质量控制。药敏试验结果按NCCL2002版判断标准，对照参考菌株判断敏感，中介和耐药。结果分离的142株肺炎链球菌的送检科室以呼吸科最多62株，其次是小儿监护病房21株，新生儿科送检标本中未培养出肺炎链球菌。分离的142株肺炎链球菌的标本以痰液标本最多103株。分离的142株肺炎链球菌对克林霉素，红霉素的耐药率分别为98．5％和95．07％且呈现逐年上升；对氨苄西林、氨苄西林舒巴坦钠、头孢呋辛、头孢曲松和万古霉素的敏感率分别为84．51％、89．44％、93．66％、97．89％和100％。结论本地区住院儿童的肺炎链球菌来源仍以呼吸道为主，对广谱半合成青霉素仍较敏感，对β-内酰胺酶抑制剂的广谱半合成青霉素敏感率更高，对头孢类敏感率更高，未发现对万古霉素耐药菌株。在门急诊可选用广谱半合成青霉素作为治疗肺炎链球菌的首选用药，在病房可选用敏感性更高的头孢呋新或头孢曲松治疗肺炎链球菌．但为了延缓耐药性的产生，应动态监测肺炎链球菌的耐药情况，合理选择抗生素，提高疗效。

Drug resistance analysis on Streptococcus pneumoniae from 142 cases infection in children

Objective To analyze the distribution and antibiotic resistance of Streptococcus pneumoniae （SP） in pediatric ward. Methods During the time between 1st Jan 2010 to 31th Dec 2012, a total of 142 strains of SP from hospitalized patients were isolated and identified in application of VITEK-60 type BioMerieux automatic microbe analysis instrument. The susceptibility test was performed by disc agar diffusion （ K-B method） and the results were assessed according to NCCL （National center for clinical laboratories） 2002 version to be judged as drug sensitive, intermediate, and resistant in contrast with standard controlled strains. Results Among the total of 142 strains of SP, 62 strains were isolated from the department of respiratory where the infection was dominating, followed by the pediatric intensive care unit （21 strains isolated）. None of the 142 stains were isolated in the samples from the neonatology department. 103 strains of SP were isolated from the sputum sample, taking the largest part of the to- tal. The resistance of 142 strains of isolated SP to clindamycin and erythrocin were 98.59% and 95.07% , showing an upward trend. The sensitivity to ampicillin, Ampicillin sulbactam, cefuroxime, ceftriaxone and vancomycin were 84.51%, 89.44%, 93.66%, 97.89% and 100% respectively. Conclusion From the isolated SP, most of which were infected in the respiratory tract were relatively sensitive to broad spectrum semisynthetic penicillin and especially sensitive to β-1actamase inhibitor combined with broad spectrum semisynthetic penicillin. While majority of the strains are sensitive to cephalosporin, all of them are sensitive to vancomycin. According to the results, broad spectrum semisynthetic penicillin are highly recommended to be the first priority in treating with patients infected with SP at the outpatient and emergence department, the use of cefuroxime and ceftriaxone are recommended at inpatient ward. However, in order to slow down the development of drug resistance, it is necessary to carry out dynamic monitoring in drug resistance of SP to guide clinical selection of antibiotics and to improve the curative effect.