2005—2009年温州育英儿童医院下呼吸道感染患儿肺炎链球菌耐药性分析

Resistance analysis of Streptococcus pneumoniae in children with lower respiratory tract infection in Wenzhou area between 2005 and 2009

目的分析下呼吸道感染儿童肺炎链球菌(SP)对常用抗生素的药敏情况。方法采用回顾性分析方法,收集2005年1月至2009年12月温州医学院附属育英儿童医院住院患儿痰培养SP阳性且临床诊断为下呼吸道感染(包括支气管炎、毛细支气管炎、肺炎等)病例的药敏资料,分析其肺炎链球菌对常用抗生素的耐药。结果共检出643株SP,5年间SP对各种抗生素的不敏感率(中介率+耐药率)较高的前10位的药物依次为:红霉素99.3%、阿奇霉素98.6%、氯林可霉素98.3%、复方磺胺甲口恶唑95.0%、头孢克洛94.6%、头孢呋辛94.1%、四环素93.6%、青霉素93.2%、美罗培南87.4%、头孢噻肟77.9%,无耐万古霉素菌株。青霉素敏感SP组与青霉素不敏感SP组对红霉素、头孢呋辛、头孢噻肟、头孢吡肟、头孢克洛、头孢曲松、阿莫西林/棒酸、阿莫西林、美罗培南的耐药性比较均P<0.05,对氯林可霉素、氨苄青霉素、四环素、复方磺胺甲口恶唑、环丙沙星、壮观霉素、左氧氟沙星和阿奇霉素等抗菌药物均P>0.05。红霉素敏感SP组与红霉素不敏感SP组对氯林可霉素、青霉素、四环素、阿奇霉素的耐药性比较均P<0.05,对头孢菌素、复方磺胺甲口恶唑、环丙沙星、阿莫西林/棒酸、左氧氟沙星、阿莫西林、氯霉素和美罗培南等抗菌药物均P>0.05。结论温州医学院附属育英儿童医院所在地区下呼吸道感染患儿SP耐药形势严峻,不同药物呈不同程度逐年增高趋势,应引起临床足够重视。

Objective To examine the resistance of Streptococcus pneumoniae （SP） to common antimicrobial drugs in children with lower resliratory tract iection in Wenzhou area between 2005.1 and 2009.12. Methods Susceptibility data of lower respiratory tract itffeetion by Streptococcus pneumoniae in children discharged from Jan.2005 Io Dec.2009 were reviewed. The children hospitalized in Yuying Children＇s Hospital affiliated to Wenzhou Medical College.Lower re- spiratory tract infection included bronchitis, bronchiolitis and pneumonia. Results Totally 643 strains of Streptococcus pneumoniae were found; in the 5 years, the order of top ten rates in the drug resistance was as follows： erythromycin 99.3%, azithromycin 98.6%, chlorine lincomycin Su 98.3%, sulfamethoxazole 95.0%, cefaclor 94.6%, cefuroxime 94.1%, tetracycline 93.6%, penicillin 93.2%, meropenem 87.4%, cefotaxime 77.9%.There was non-Vancomycin-resistant strain. The comparisons between penicillin-susceptible streptococcus pnenmoniae and penicillin non-susceptible streptococcus pneumoniae to erythromycin, cefuroxime, cefotaxime, cefepime, cefaclor, ceftriaxone, amoxicillin/clavulanic acid, amoxi- cillin and meropenem were all P 〈 0.05.However, the comparisons to clindamycin, ampicillin, tetracycline, sulfamethoxazole, ciprofloxacin, spectinomycin, levofloxacin and azithromycin were all P 〉 0.05. The comparisons between erythromy- ein-susceptible streptococcus pneumoniae and eythromycin non-susceptible streptococcus pneumoniae to clindamycin, penicillin, tetracycline and azithromycin were all P 〈 0.05. And the comparisons to cephalosporins, sulfamethoxazole, ciprofloxacin, amoxicillin/clavulanic acid, levofloxacin, amoxicillin, chloramphenicol and meropenem were all P 〉 0.05. Conclusion The situation of SPresistance in children from Wenzhou with lower respiratory tract infection is grim. The levels of different drugs increased year by year in different degrees, which should be paid enough dinical attetion.