2000—2002年北京、上海和广州儿童肺炎链球菌携带及抗生素耐药性监测

Carrier rate of Streptococcus pneumoniae and susceptibility thereof to antimicrobial drugs among children in China: a surveillance study in Beijing, Shanghai, and Guangzhou 2000—2002

目的了解当前我国儿童携带肺炎链球菌情况,及该菌对常用抗生素的敏感性分布,为临床合理用药提供依据。方法2000—2002年于北京、上海和广州3家儿童医院门诊就诊的年龄为1个月至5岁急性上呼吸道感染儿童鼻咽部分离肺炎链球菌,采用纸片扩散法和E-test法检测菌株对10种抗生素的敏感性。结果肺炎链球菌分离率24·9%。肺炎链球菌对青霉素的不敏感率达39·9%,耐药率6·4%;20·4%的菌株对头孢克洛耐药;19·0%的菌株对头孢呋辛不敏感;肺炎链球菌对阿莫西林/克拉维酸和头孢曲松的敏感率分别为98·5%和97·2%。对红霉素、复方新诺明和四环素的不敏感率都在80·0%以上。98·0%的菌株对环丙沙星敏感。3城市肺炎链球菌抗生素敏感性变化有各自的特点。耐药模式分析表明多重耐药率达88·7%,青霉素不敏感肺炎链球菌(PNSP)较青霉素敏感菌(PSSP)更为多见(99·1%和78·8%,P<0·01);红霉素不敏感菌株较红霉素敏感菌株也更为多见(95·8%和17·1%,P<0·01)。结论我国肺炎链球菌对抗生素的耐药状况已很严峻,不同地区肺炎链球菌的耐药性变化具有不同特点。必须加强各地肺炎链球菌耐药性和抗生素使用情况的监测,及时调整经验用药方案和公共卫生策略。

Objective To investigate the carrier rate of Streptococcus pneumoniae and the susceptibility of S. pneumoniae to 10 different antimicrobial drugs among children in China. Methods Nasopharageal swab specimens were collected from randomly selected 3578 out-patients with upper respiratory infection aged i month to 5 years in Beijing, Shanghai, and Guangzhou 2000-2002 so as to isolate S. pneumoniae. The susceptibility of these starins to erythromycin and β-1actam antibiotics （penicillin, amoxicillin/clavulanic acid, cefaclor, cefuroxime and ceftriaxone） was determinated by E-test MIC method, and the susceptibility to chloramphenicol, tetracycline, sulfamethoxazole/trimethoprim and ciprofloxacin was determinated by disk diffusion method. Results A total of 892 strains of S. pneumoniae were isolate from the 3578 children with a carrier rate of 24.9% （9.0% ～ 36.0% ）. 634 isolates of S. pneumoniae were tested to examine their susceptibility to chloramphenicol, 199 to ciprofloxacin, and 887 to the other 8 antimicrobial drugs. The insusceptibility rate of S. pneumon/ae to penicillin was 39.9%, and the resistance rate was 6. 4%. The resistance rate to cefaclor was 20. 4%. The insusceptibility rate to cefuroxime was 19.0%. The susceptibility rate to amoxicillin/ clavulanic acid was 98.5% and that to ceftriaxone was 97.2%. More than 80% of the isolates were resistant to erythromycin, tetracycline, and sulphamethoxazole/trimethoprim. Chloramphenicol resistance was less common （32. 3% ） than the resistance to other non-β-1actam antibiotics, except for ciprofloxacin to which the resistance rate was 2.0%. The national insusceptibility rates for β-1actam antibiotics did not vary significandy during the three years with the widest varying range of 5.1% for penicillin （38.1% ～ 43.2% ）. Each of the three cities had their different varying patterns of antimicrobial susceptibility, especially for β-1actam antibiotics. Multi-drug resistance was common （88.7%）. Strains of S. pneumoniae insusceptible to penicillin were significantly more common than those susceptible to penicillin （ 99. 1% vs. 78.8% , χ^2 = 50.36, P 〈 0. 001 ）, and strains of S. pneumoniae insusceptible to erythromycin were significantly more common than those susceptible to erythromycin too （95.8% vs. 17.1%, χ2 = 360.26 ,P 〈 0.001 ）. Conclusion Antimicrobial resistant S. pneumoniae has already become a serious problem in China. Ongoing surveillance study on the antimicrobial resistance of S. pneumoniae is neccarery for appropriate antimicrobial use in clinical work and modification of medical strategies for people＇s health.