2005—2006年中国社区呼吸道感染细菌耐药性监测

Surveillance of bacterial resistance in community-acquired respiratory tract infections during 2005—2006 in China

目的调查2005-2006年社区呼吸道感染常见病原菌对头孢克洛及其他5种抗菌药物的耐药性。方法收集2005年10月-2006年8月全国6个地区6所医院社区呼吸道感染患者中分离的流感嗜血杆菌（280株）、肺炎链球菌（105株）、卡他莫拉菌（61株）、β溶血链球菌（30株）和MSSA（30株）共506株。菌株统一由北京医院作复检并用E试验测定头孢克洛等6种抗菌药物的MIC。结果流感嗜血杆菌是社区获得性肺炎（CAP）和慢性支气管炎急性发作（AECB）等感染的最重要的病原菌。分别占CAP56.9％（202株）和AECB64.5％（93株）。药敏结果显示，青霉素敏感的肺炎链球菌（PSSP）为50.5％，青霉素中介肺炎链球菌（PISP）为31.4%，青霉素耐药肺炎链球菌（PRSP）为18.1％。青霉素不敏感率以上海和广州最高（78.6％），其他依次为四川（50％）、天津（46.7%）、浙江（37.5％）和北京（21.1％）。有21.1％的流感嗜血杆菌和93，4％的卡他莫拉菌产生β内酰胺酶。流感嗜血杆菌对头孢克洛、头孢丙烯、阿奇霉素、氨苄西林和莫西沙星分别有98.6％、97.8％、98.6％、85.8％和100％的敏感率。阿奇霉素对肺炎链球菌、β溶血链球菌和MSSA耐药率分别高达94，3％、60％和56.7％。头孢克洛对流感嗜血杆菌和卡他莫拉菌的MIC值低于头孢丙烯1／2。结论与2003年监测结果比较，肺炎链球菌对青霉素的耐药率有较快的增长；流感嗜血杆菌和卡他莫拉菌的产酶率呈上升趋势；肺炎链球菌、G溶血链球菌和MSSA3种革兰阳性球菌对阿奇霉素的耐药率升高；头孢克洛对社区呼吸道感染常见病原菌保持70％～100%的敏感性，提示仍可作为轻中度社区呼吸道感染的选用药物。

Objective To investigate antimicrobial resistance of bacterial pathogens isolated from community acquired respiratory tract infections to cefaclor and other 5 antimicrobial agents during 2005-2006. Methods A total of 506 bacterial isolates were collected, including 280 strains of H. influenzae, 105 S. pneumoniae, 61 M. catarrhalis, 30 oxacillin-susceptible S. aureus （MSSA） and 30 beta-hemolytic Streptococcus from 6 hospitals. The strain identification confirmation and E-test were conducted in Beijing Hospital. Results H. influenzae was isolated from 56.9% （115/202） of the patients with community-acquired pneumonia （CAP）, and 64.5% （60/93） of the patients with acute exacerbation of chronic bronchitis （AECB）. Results of susceptibility testing showed that the prevalence of penicillin-susceptible S. pneumoniae （PSSP） was 50. 5%. About 31. 4% of the S. pneumoniae isolates were penicillin-intermediate S. pneumoniae （PISP）, and 18.1 % of the S. pneumoniae isolates were penicillinresistant S. pneumoniae （PRSP）. The highest prevalence of penicillin-non-susceptible S. pneumoniae （PNSP） was found in Shanghal and Guangzhou （78.6%）, followed by Sichuan （50%）, Tianjin （46.7%）, Zhejiang （37.5%） and Beijing （21.1 %）. Beta-lactamase was produced in 21. 1 % of H. influenzae isolates and 93.4% of M. catarrhalis isolates. The 98.6%, 97.8G, 98.6%, and 85.8% of the H. influenzae isolates were susceptible to cefaclor, cefprozil, azithromycin, ampicillin and moxifloxacin respectively. The resistance rates of S. pneumoniae, beta-hemolytic Streptococcus and MSSA to azithromycin were 94.3%, 60% and 56.7% respectively. The MIC values of cefaclor were 1-2 times lower than cefprozil against H. influenzae and M. catarrhalis. Conclusions The resistance rate of S. pneumoniae to penicillin is increasing rapidly compared with the surveillance results in 2003. The prevalence of β-lactamase production was rising in H. influenzae and M. catarrhalis. The resistance rate of S. pneumoniae, beta-hemolytic Streptococcus and MSSA to azithromycin was high. Cefaclor still maintains good in vitro activity for most bacterial isolates （70%-100%） from communityacquired respiratory tract infections. It should be recommended as a good choice for mild to moderate community-acquired respiratory tract infections.