四家儿童医院住院肺炎病例肺炎链球菌分离株的耐药性监测

Surveillance of antibiotic resistance of Streptococcus pneumoniae isolated from hospitalized patients with pneumonia in four children's hospitals in China

目的了解从我国住院肺炎儿童分离的肺炎链球菌对抗菌药物的敏感性状况,为临床用药提供依据。方法肺炎链球菌分离自2006年2月～2007年2月在北京、上海、广州和深圳4家儿童医院住院的肺炎患儿,采用E试验法检测菌株对8种抗生素的敏感性。结果279株肺炎链球菌对青霉素的不敏感率为86.0%,耐药率达23.3%。在检测的β内酰胺类抗菌药物中,肺炎链球菌对阿莫西林还保持着很高的敏感率(92.1%),对头孢呋辛和头孢曲松的敏感率分别为19.0%和75.3%。几乎全部菌株(99.6%)对红霉素耐药。万古霉素和氧氟沙星的敏感率分别为99.6%和97.8%。17.6%的分离株对亚胺培南不敏感,以中介株为主。不同地区分离的肺炎链球菌对红霉素、万古霉素和氧氟沙星的敏感状况没有明显不同,但对其他几种抗菌药物的敏感性状况存在差异。结论从肺炎住院儿童分离的肺炎链球菌对阿莫西林、万古霉素和氧氟沙星敏感率高,对头孢曲松和亚胺培南比较敏感,对青霉素、头孢呋辛和红霉素普遍不敏感或耐药。

Objective To investigate the antimicrobial resistance of Streptococcus pneumoniae （S. pneumoniae ） isolated from Chinese children with pneumonia. Methods Hypopharyngeal aspirate specimens were collected from hospitalized children with pneumonia who were admitted to the children＇s hospital located in Beijing, Shanghai, Guangzhou or Shanghai from Feburary 16, 2006 to Feburary 16, 2007. The minimum inhibitory concentration （MIC） of S. pneumoniae isolates against penicillin, amoxicillin, cefuroxime （sodium）, ceftriaxone, erythromycin, vancomycin, ofloxacin and imipenem was determined by E-test method. Results A total of 279 S. pneumoniae isolates were obtained. Eighty-six percent of the isolates were not susceptive to penicillin, and 23.3% was resistant to penicillin. The rate of susceptibility of the isolates to amoxicillin was 92. 1% , and to cefuroxime and ceftriaxone was 19.0% and 75.3% , respectively. The isolates also showed a high susceptibility to vancomycin （99.6%） and ofloxacin （97.8%）. Seventeen point six percent of the isolates were not susceptive to imipenem, and most of those were intermediate. Almost of all isolates were resistant to erythromycin. There were some distinct regional differences in the susceptibility to antimicrobials tested except for erythromycin, vancomycin and ofloxacin. Conclusions The S. paeumoniae isolates from Chinese children with pneumonia were susceptive to amoxicillin, vancomycin and ofloxacin, but were not susceptive or resistant to penicillin, cefuroxime and erythromyein. The isolates kept susceptibility to ceftriaxone and imipenem to a certain extent.