侵袭性和非侵袭性肺炎链球菌耐药率的比较分析

Comparsion of antimicrobial-resistant profiles of Streptococcus pneumoniae from invasive and non-invasive infections

目的研究侵袭性和非侵袭性肺炎链球菌的耐药谱的差异,指导合理应用抗生素及感染管理。方法回顾性统计分析2009至2011年来天台县人民医院就诊患者分离肺炎链球菌的标本来源及耐药性,比较侵袭性和非侵袭性肺炎链球菌耐药率之间的差异。结果共分离出肺炎链球菌642株,痰液中分离出584株,非痰液中分离出58株,其中血液中分离出32株,脑脊液中分离出20株,其他分离出6株,所有肺炎链球菌对万古霉素和利奈唑胺均敏感,对青霉素、红霉素、克林霉素、四环素及复方新诺明耐药严重,对左氧氟沙星、氯霉素比较敏感;侵袭性分离株对青霉素、红霉素、克林霉素、左氧氟沙星、四环素及氯霉素的耐药率显著高于非侵袭性肺炎链球菌。结论该院分离的肺炎链球菌主要来自痰液标本,耐青霉素肺炎链球菌的检出率高,大环内酯类耐药严重,存在一定比例的侵袭性感染,非侵袭菌株与侵袭性菌株耐药谱之间存在一定差异,临床治疗应该区别对待,系统的监测细菌耐药性,合理选择抗菌药物。

Objective To investigate the distribution and drug resistance of Streptococcus pneumoniae isolated from patients with invasive and non-invasive infections for reasonable application of antibiotics and control infection. Method Bacte- ria isolated from patients with invasive and non-invasive infections in our hospital from 2009 to 2010 were identified, and their sensitivity to antibiotics were tested and analyzed. The resistance difference between the invasive and non-invasive infections strains was compared. Result A total 642 strains were isolated, of which 584 strains from sputa and 58 strains from non-spu- tum specimens, in cluding 32 strains from blood, 20 strains from cerebrospinal fluid and 6 strains from others. All strains were sensitive to vancomycin and linezolid. The resistance to penicillin, erythromycin, clindamycin, tetracycline and SMZ-TMP was serious, but the strains were more sensitive to levofloxacin and chloramphenicol. The resistance rates of invasive isolates to penicillin, erythromycin, clindamycin, levofloxacin, tetracycline and chloramphenicol were significantly higher than those of non-invasive strains. Conclusion Streptococcus pnet^moniae isolates in our hospital are mainly from sputum specimens, the i- solating rate of PNSP is higher and the drug resistance rates to macrolides are serious. There also exists a certain proportion of invasive infections. There are certain differences of the resistant rates between non-invasive and invasive strains. So we shall use different strategy in treatment of non-invasive and invasive infections. A systematic monitoring of drug resistance is the pre- requisite for rational use of antibiotics .