2001年至2011年沈阳地区肺炎链球菌感染分布及耐药性变迁

Changes in drug resistance and distribution of Streptococcus pneumonia infection from 2001 to 2011 in Shenyang area

目的了解肺炎链球菌对青霉素等10种抗生素耐药性的动态变迁、感染病例的科室分布及耐药现状，为临床治疗肺炎链球菌感染提供参考依据。方法采用法国生物梅里埃API鉴定系统、VITEK2-COMPACT鉴定系统以及Optochin试验、胆汁溶解试验进行细菌鉴定；用K—B纸片扩散法联合浓度梯度法对青霉素、头孢噻肟等10种抗生素进行体外药敏试验，对2001年至2011年各年药敏结果进行分析。结果11年来肺炎链球菌对临床常用抗生素的耐药率逐年上升，特别是青霉素的耐药率和不敏感率明显上升，已从2001年的8．3％上升至2011年的72．7％（脑膜炎86．4％，非脑膜炎59．0％）；3代头孢菌素头孢噻肟的耐药率已占54．0％（脑膜炎64．0％，非脑膜炎44．0％）；大环内酯类抗菌药物的耐药率为100％；未检测到万古霉素和利奈唑胺耐药菌株。结论青霉素不敏感的肺炎链球菌已占很高的比例，肺炎链球菌青霉素、头孢菌素、大环内酯类抗菌药物耐药情况严重。临床在治疗肺炎链球菌引起的重症感染病例中应首选万古霉素和利奈唑胺或根据分离菌体外药敏结果选择合适的抗菌药物。

Objective To investigate the dynamic changes of infectious distribution,current resistant situation of Streptococcus pneumoniae（SP） and resistant to penicillin and other 10 kinds of antibiotics for the guidance of clinical therapy of SP. Methods Bacteria were identified by French BioMerieux API identifica- tion system, VITEK 2-COMPACT identification system and Optochin test, bile solubility test. In vitro, drug susceptibility test to penicillin, cefotaxime, and other 10 kinds of antibiotics were conducted with K-B disk diffusion method combined with the concentration gradient method. Drug susceptibility results were analyzed from 2001 to 2011. Results In recent 11 years,SP antimicrobial resistance rate had increased year after year, especially rates of penicillin-resistant and penicillin not-sensitive had increased significantly ,rising from 8. 3% （ in 2001 ） to 72.7% （ in 2011 ） （ meningitis 86. 4%, non-meningitis 59. 0% ）. Resistance rate of cefotaxime, belonging to third-generation cephalosporin had already accounted for 54. 0% （meningitis 64. 0%, non-menin- gitis 44. 0% ） ;and the resistance rate of macrolide antimicrobial was 100% ;vancomycin-resistant strains and linezolid-resistant strains had not been detected. Conclusion Penicillin non-susceptible SP has accounted for a high percentage, antimicrobial resistance of Streptococcus pneumoniae penicillin, cephalosporins, macrolides are in serious condition. Vancomycin and linezolid should be preferred or the right antibiotics be chosen according to vitro susceptibility results of isolates in clinical treatment of severe infections caused by SP.