儿童社区获得性肺炎病例肺炎链球菌分离株的耐药分析

Analysis of the Antibiotic Resistance of Streptococcus Pneumonia Isolated from Community Acquired Pneumonia in Children

目的分析昆明地区社区获得性肺炎住院病例中肺炎链球菌感染的耐药状况.方法对2007年1月至2010年12月间年龄28 d～8岁的4 780例诊断为社区获得性肺炎(CAP)住院患儿进行痰培养,采用链球菌细菌鉴定板鉴定,并行药敏试验.结果从所检测CAP患儿痰液中培养分离出344株肺炎链球菌,它们对青霉素不敏感率为45.6%;2007年至2008年肺炎链球菌对青霉素、红霉素、克林霉素、头孢噻肟、头孢曲松、氧氟沙星的耐药率分别为38.5%、38.3%、4.8%、16.0%、16.4%、3.6%;2009年至2010年SP对上述药物的耐药率分别为60.9%、68.0%、42.6%、36.7%、32.3%、3.1%;未检出对万古霉素耐药的菌株.青霉素不敏感肺炎链球菌(PNSSP)对红霉素、克林霉素、头孢噻肟、头孢曲松、氧氟沙星的耐药率均高于青霉素敏感肺炎链球菌(PSSP).结论 CAP患儿住院病例中分离到的肺炎链球菌对万古霉素、氧氟沙星的敏感性极高,对青霉素、红霉素、克林霉素、头孢噻肟、头孢曲松的耐药率出现逐年增加的趋势.

Objective To analyze the antibiotic resistance of Streptococcus pneumonia of community acquired pneumonia（CAP）in children.Methods From Jan 2007 to Dec.2010,efforts were made to isolate S.pneumonia from throat swab and sputum samples in 4780 children with CAP,aged from 28 days to 8 years old,and to test the antimicrobial susceptibility of these clinical isolates by means of sputum culture and streptococcus bacteria identification plate identification.Results A total of 344 strains of S.pneumonia were isolated from throat swab and sputum.The prevalence of S.pneumonia non-susceptible to penicillin was 45.6%.The resistance rates of S.pneumonia to the commonly used antibiotic were penicillin 38.5%,erythromycin 38.3%,clindamycin 4.8%,cefotaxime 16.0%,ceftriaxone 16.4% and ofloxacin 3.6% during the period from 2007 to 2008,respectively.From 2009 to 2010,the resistance rates of S.pneumonia to the antibiotic were increased;it was 60.9%,68.0%,42.6%,36.7%,32.3% and 3.1%,respectively.No vancomycin resistance strain was found.The resistance rate of penicillin non-susceptible S.pneumonia（PNSSP） was higher than that of penicillin susceptible S.pneumonia（PSSP）.Conclusion The S.pneumonia isolated from children with CAP is susceptive to vancomycin and ofloxacin.There is an increasing tendency of the resistance rates of S.pneumonia to penicillin,erythromycin,clindamycin,cefotaxime and ceftriaxone in Kunming region.