儿童流感嗜血杆菌感染临床特征及药敏分析

Clinical characteristics of children's infection with haemophilus influenzae and the resistance analysis

目的 了解流感嗜血杆菌在儿童中的感染情况及特点 ,为预防儿童流感嗜血杆菌感染和合理使用抗生素提供参考。方法 对复旦大学儿科医院 2 0 0 0年 1月至 2 0 0 2年 12月期间住院呼吸道感染患儿采用一次性鼻导管深插气管 ( 10～ 15cm)负压吸取痰液 ,部分患儿采集咽拭子、脑脊液、血液及其他体液做细菌培养。结果 共获痰标本 12 5 6 0份 ,其他体液、分泌物等共 84 94份 ,其中脑脊液 888份。 ( 1)培养流感嗜血杆菌阳性 4 2 0株 ( 4 2 0个病例 )。 2 0 0 0、2 0 0 1、2 0 0 2年分别为 10 1株、173株和 14 6株。 ( 2 )流感嗜血杆菌感染同时合并其他病原体感染病例有 172例 ( 4 0 1% ) ,支原体和呼吸道合胞病毒 (RSV) ,各占混合感染组中的 2 5 0 %。 ( 3) 4 2 0例病例中 ,<6个月患儿占 2 2 9% ,～ 12个月龄患儿占 2 0 2 % ,～ 3岁患儿占 2 7 4 % ,～ 5岁患儿占 15 7% ,≥ 5岁患儿为 13 8%。 ( 4 ) 3年药敏平均耐药率结果 :氨苄西林为 13 6 % ,头孢唑林、头孢克洛、头孢噻肟的耐药率分别为 16 1%、7 7%和 4 0 % ,氯霉素的耐药率为 5 9%。 2 0 0 1和 2 0 0 2两年药敏平均耐药率结果 :氨苄西林 /舒巴坦的耐药率为 13 2 % ,环丙沙星耐药率为 0 9%。 2 0 0 2的药敏结果显示 ,阿奇霉素的耐药率仅为 0 8%

Objective To investigate the incidence and clinical characteristics of Haemophilus influenzae(Hi) infection in children.Methods The data of bacteria culture in sputum,blood and other body fluid from Jan 2000 to Dec 2002 were collected.The incidence of Hi infection and its resistance rate to different anti bacteria therapy were calculated and compared between different years.Results 420 Hi strains from 420 cases had been isolated in the three years.172 of them were found coinfected with other pathogens.Mycoplasma and respiratory syncytial virus were the two dominated pathogens.Children under five years old were likely infected by Hi,compared with other age groups.The average drug resistance rate in the three years to Ampicillin,Cefazolin,Ceclor,and Cefotaxime was 13 6%,16 1%,7 7%and 4 0% respectively,to chloramphenicol was 5 9%.The calculated results in 2001 and 2002 showed that Amipicillin/Subactan was 13 2%,and to Ciproloxacin was 0 9%.In 2002,resistance rate to Azithromycin was 0 8%,to Sulfamethoxazole/Trimethoprim was 59 6%.Conclusion Haemophilus influenzae is an important bacteria pathogen in acute respiratory infection in children in Shanghai area.The incidence of resistance strains to different anti bacteria therapy is increasing rapidly.Cefazolin is not suitable as the first line medicine in treatment of Hi infection.