儿童细菌性皮肤病的病原菌分布与耐药性分析

Analysis of the distribution and resistance of bacterial strains isolated from children with bacterial dermatic infection

目的分析细菌感染性皮肤病住院患儿病原菌分布及耐药性,指导临床合理用药。方法对253例细菌性皮肤病住院患儿进行细菌分离培养,VITEK-AMS60微生物鉴定仪进行病原菌鉴定和药敏试验。结果从253例患儿标本中分离出病原菌216株,其中葡萄球菌211株,占97.7%,A组β-溶血性链球菌(GABHS)5株,占2.3%。葡萄球菌药敏试验结果显示,对氨苄西林/克拉维酸、苯唑西林、头孢唑林、红霉素、环丙沙星和复方磺胺甲噁唑,前3年组(2004—2006年)的耐药率分别为96.6%、94.3%、94.3%、82.8%、21.5%和25.3%,后3年组(2007—2009年)的耐药率分别为97.6%、95.2%、96.8%、91.1%、25.0%和31.5%,各组间差异无统计学意义(P>0.05);但前3年组对克林霉素和庆大霉素的耐药率分别为44.8%和26.4%,后3年组的耐药率分别为81.5%和65.3%,后3年组耐药率高于前3年组(P<0.01和P<0.01);5株GABHS中,4株对红霉素耐药、4株对阿奇霉素耐药,对青霉素、莫匹罗星全部敏感。尚未发现耐万古霉素的菌株。结论葡萄球菌是细菌性皮肤病的主要病原菌;葡萄球菌具有多重耐药性,对克林霉素和庆大霉素的耐药性在增高。

Objective To analyze the distribution and resistance of bacterial strains isolated from hospitalized children with bacterial dermatic infection and guide antibiotics chemotherapy in clinics.Methods Cultures were obtained from 253 hospitalized children with bacterial dermatic infection.Then the bacteria identification and antimicrobial susceptibility were assayed by the VITEK-AMS60.Results 216 strains of pathogens were isolated,including 211 strains of Staphylococcus（97.7%） and 5 strains of Group A β-hemolytic streptococcus（GABHS）（2.3%）.The results of antibiotic susceptibility tests on 211 strains of staphylococcus showed that the difference of resistance to ampicillin/clavulanic acid,oxacillin,cefazolin,erythrocin,ciprofloxacin and SMZ/TMP between the strains isolated from the first 3 years（2004-2006） and those isolated from the later 3 years（2007-2009） was insignificant.（96.6% vs 97.6%,P0.05;94.3% vs 95.2%,P0.05;94.3% vs 96.8%,P0.05;82.8% vs 91.1%,P0.05;21.8% vs 25%,P0.05 and 25.3% vs 31.5%,P0.05.）.Comparing to the strains isolated from the first 3 years,the strains isolated from the later 3 years have a higher resistant to clindamycin and gentamycin（81.5% vs 44.8%,P0.01 and 65.3% vs 26.4% P0.01）.Four out of five GABHS were resistant to erythromycin,azithromycin,and none of the GABHS was resistant to penicillin and mupirocin in this study.None of the isolates was resistant to vancomycin.Conclusion Staphylococcus is the major infective strains in bacterial dermatic infections.These strains of Staphylococcus were multiresistant and the rates of resistance to clindamycin and gentamycin are ascending.