2020年儿童流感嗜血杆菌临床株耐药性多中心研究

A multicenter study of antimicrobial resistance profile of Haemophilus influenzae isolated in pediatric hospitals in 2020

目的了解2020年中国流感嗜血杆菌(Haemophilus influenzae,Hi)儿童株的耐药模式,为临床治疗提供依据。方法中国不同地区9家儿童医院组成ISPED协作组,由专人对Hi进行培养和鉴定。药敏试验采用Kirby-Bauer法和MIC法,β-内酰胺酶测定采用头孢硝噻吩法。结果2020年共分离到Hi菌株2244株,2104株(93.4%)来自患儿的呼吸道标本,78株(3.47%)来自阴道分泌物标本,12株(0.53%)来自血液标本,6株(0.26%)来自脑脊液标本。β-内酰胺酶阳性菌株1451株,占64.6%,耐氨苄西林的Hi占72.1%,其中β-内酰胺酶阴性耐氨苄西林的菌株占7.7%(175/1451)。菌株对复方磺胺甲恶唑、阿奇霉素、头孢呋辛、氨苄西林/舒巴坦、头孢噻肟、美罗培南的耐药率分别为65.8%、42.7%、47.5%、35.0%、6.9%和0.6%。β-内酰胺酶阳性且氨苄西林舒巴坦耐药536株,占23.9%。呼吸道来源Hi菌株对氨苄西林、氨苄西林舒巴坦钠、头孢呋辛、复方磺胺甲恶唑、阿奇霉素的耐药率高于非呼吸道来源菌株(P<0.01)。结论中国Hi儿童株对氨苄西林耐药率高,产β-内酰胺酶的Hi对氨苄西林/舒巴坦耐药率也较高,头孢噻肟等第三代头孢菌素可作为我国儿童Hi感染的首选用药。

Objective To determine the antibiotic resistance profiles of Hi isolates from Chinese children in 2020 and to provide guidelines for clinical treatment.Methods Infectious Disease Surveillance of Pediatrics(ISPED)collaboration group including nine children’s hospitals in different regions of China was established.The same protocol and guideline were used for the culture and identification of Hi.Kirby-Bauer or MICs methods were used to test antibiotic susceptibility,and a cefinase disc was used to detectβ-lactamase activity.We isolated 2,244 Hi strains in 2020:2104(93.4%)from the respiratory tract,78(3.47%)from vaginal secretions,12(0.53%)from blood and 6(0.26%)from cerebrospinal fluid.Of all 2,244 strains,64.6%(1,451/2,244)were positive forβ-lactamase and 72.1%(175/1,451)were resistant to ampicillin;7.7%wereβ-lactamase-negative and ampicillin-resistant.The resistance rates of the Hi isolates to trimethoprim-sulfamethoxazole,azithromycin,cefuroxime,ampicillin-sulbactam,cefotaxime,and meropenem were 65.8%,42.7%,47.5%,35.0%,6.9%,and 0.6%,respectively.Five-hundred and thirty-six(23.9%)wereβ-lactamase-positive and ampicillin-sulbactam-resistant.Higher resistant rates against ampicillin,ampicillinsulbactam,cefotaxime,trimethoprim-sulfamethoxazole and azithromycin were found in respiratory isolates when compared with those of non-respiratory isolates(P<0.01).Conclusions Resistant rate to ampicillin in pediatric Hi in China was high,and amongβ-lactamase-producing Hi,their resistance to ampicillin-sulbactam was high too.Cefotaxime and other third-generation cephalosporins could be the first choice for the treatment of ampicillin-resistant Hi infections.