广州地区儿童急性呼吸道感染流感嗜血杆菌耐药性和血清分型研究

Study on serotype and the resistance of haemophilus influenzae from children with respiratory tract infection in Guangzhou.

目的了解2000—2007年广州地区急性呼吸道感染儿童流感嗜血杆菌(Hi)耐药性和2000—2003年分离的Hi血清分型情况,有效指导临床合理用药。方法采集2000年1月至2007年12月广州市儿童医院门诊及住院的急性呼吸道感染患儿鼻咽分泌物或深部吸痰标本,应用Hi选择培养基进行分离培养;用E-test法检测Hi对阿莫西林/克拉维酸、头孢呋辛、头胞曲松、氨苄西林、头胞克洛的耐药性,用K-B法检测Hi对阿奇霉素、四环素、氯霉素、复方新诺明的耐药性;采用头孢硝基噻酚显色反应法检测β-内酰胺酶。用玻片凝集法对2000—2003年分离的381株Hi进行血清分型。结果在8年时间内,Hi对阿莫西林/克拉维酸、头孢呋辛、头胞曲松、阿奇霉素敏感性较高,对氨苄西林、头胞克洛、氯霉素、四环素的耐药率呈逐年上升趋势,复方新诺明的耐药率高达72.13%;氨苄西林耐药的Hi多重耐药率达82.51%。Hi的产酶率也由2000年的9.91%上升到2007年的36.48%。2000—2003年所分离381株Hi的血清分型以不定型株为主,占95.53%,Hib仅占1.57%。结论广州地区急性呼吸道感染儿童流感嗜血杆菌血清分型以不定型株为主,Hib分离率不高;广州地区急性呼吸道感染儿童Hi的耐药性和产酶率有逐年上升趋势;治疗Hi感染以β-内酰胺类抗菌药物为首选。目的了解2000—2007年广州地区急性呼吸道感染儿童流感嗜血杆菌(Hi)耐药性和2000—2003年分离的Hi血清分型情况,有效指导临床合理用药。方法采集2000年1月至2007年12月广州市儿童医院门诊及住院的急性呼吸道感染患儿鼻咽分泌物或深部吸痰标本,应用Hi选择培养基进行分离培养;用E-test法检测Hi对阿莫西林/克拉维酸、头孢呋辛、头胞曲松、氨苄西林、头胞克洛的耐药性,用K-B法检测Hi对阿奇霉素、四环素、氯霉素、复方新诺明的耐药性;采用头孢硝基噻酚显色反应法检测β-内酰胺酶。用玻片凝集法对2000—2003年分离的381株Hi进行血清分型。结果在8年时间内,Hi对阿莫西林/克拉维酸、头孢呋辛、头胞曲松、阿奇霉素敏感性较高,对氨苄西林、头胞克洛、氯霉素、四环素的耐药率呈逐年上升趋势,复方新诺明的耐药率高达72.13%;氨苄西林耐药的Hi多重耐药率达82.51%。Hi的产酶率也由2000年的9.91%上升到2007年的36.48%。2000—2003年所分离381株Hi的血清分型以不定型株为主,占95.53%,Hib仅占1.57%。结论广州地区急性呼吸道感染儿童流感嗜血杆菌血清分型以不定型株为主,Hib分离率不高;广州地区急性呼吸道感染儿童Hi的耐药性和产酶率有逐年上升趋势;治疗Hi感染以β-内酰胺类抗菌药物为首选。

Objective This study was designed to dynamically investigate resistance and serotyping of Haemophilus influenzae （Hi） isolated from children＇s respiratory tract during 2000-2007. Methods The specimens of sputum and swabes from children with acute respiratory tract infection were collected and incubated on improved Collumbia chocolate medium. Totally 381 Hi strains isolated during 2000-2003 were serotyped by Haemophilus Influenzae Antiserum. Results The prevalence of β- lactamase was 30.75% in all Hi isolates. Hib and NTHi were 1.57% and 95.53% among 381 Hi strains isolated during 2000-2003. The Hi isolates were slightly resistant to amoxicillin-clavulanic , ceftriaxone, cefaclor, and cefuroxime, the resistant rate to ampicillin and chloramphenicol being 12.61% -41.60% and 10.81% -21.11% respectively. About 13.51% -44.24% of Hi isolates were resistant to tetracycline and 41.20% -72.13% resistant to trimethoprim-sulfamethoxazole. Conclusion NTHi is the major serotype of Hi in children with acute respiratory tract infection. The prevalence of Hib is low. The resistant rate to ampicillin, chloramphenicol, tetracycline and trimethoprim-sulfamethoxazole are increasing. The use of β-lactamase is the first choice in the treatment of infections caused by Hi.