急性上呼吸道感染流感嗜血杆菌耐药性分析

Drug resistance study of hemophilies influenzae in acute upper respiratory infection

目的了解大连地区儿童急性上呼吸道感染流感嗜血杆菌(Hi)的感染情况及耐药性,以便有效指导临床合理用药。方法对1100例急性上呼吸道感染儿童鼻咽分泌物进行Hi培养、采用api-NH鉴定卡及药敏条进行细菌鉴定和药敏试验。β-内酰胺酶试验采用Cefinase纸片法。结果分离出Hi217例(19.7%),检出菌株对利福平、氧氟沙星、头孢呋辛、第3代头孢类抗生素未发生耐药;对其他抗生素的耐药率分别为复方磺胺甲恶唑84.6%、氨卞西林69.2%、四环素38.5%、头孢克洛26.9%、氯霉素19.2%、阿莫西林/克拉维酸15.4%。β-内酰胺酶阳性57.6%。结论本地区儿童急性上呼吸道感染Hi耐药形势严峻,产β-内酰胺酶率较高,以复方磺胺甲恶唑、四环素、氯霉素的多重耐药为特点,应引起重视。

Objective To investigate the infectious state and drug resistance of hemophilies influenzae （Hi） in children with acute upper respiratory infection in Dalian area, so as to instruct the rational use of antibiotics. Methods 1100 specimens of nasopharyngeal secretions were collected from children with acute upper respiratory infection and cultured. Hi was identified by api-NH identification card and its drug resistance was determined by sensitivity test strip. Cefinase slip test was applied to detecting β-lactamase. Results 217 strains （19.7%） of Hi were isolated. The Hi strains were not resistance to rifampin, ofloxacin, cefuroxime sodium, the third cephalospothins; the resistant rate to TMP-SMZ, ampicillin, tetracycline, cefaclor, chloramphenicol, amoxicillin/clavulanic-acid was 84.6 %, 69. 2%, 38.5%, 26.9%, 19.2%, and 15.4% respectively. The β-lactamase positive rate was 57.6%. Conclusion The drug resistance of Hi is conspicuous in children with acute upper respiratory infection in Dalian area. The β-lactamase positive rate is high. The drug resistance is characterized by multi-resistance to TMP-SMZ, tetracycline and chloramphenicol.