2010年儿童痰培养肺炎链球菌的阳性率及药敏分析

Positive rate and drug susceptibility of Streptococcus pneumoniae cultured from sputum of children in 2010

目的测定肺炎链球菌在痰标本的阳性率及药敏分析,为临床合理用药提供依据。方法收集医院2010年1月-12月住院患儿感染性肺炎痰标本691例,用ATB系统进行鉴定并行药敏试验。结果 691份痰标本检出肺炎链球菌155株,阳性率22.4%,对青霉素、阿莫西林、头孢噻肟、红霉素、喹奴普汀/达福普汀、克林霉素、四环素、左氟沙星、氯霉素和万古霉素的敏感率分别为74.5%、67.2%、67.9%、0.7%、88.3%、3.6%、10.2%、100.0%、87.6%、100.0%;青霉素敏感肺炎链球菌敏感率明显高于耐青霉素肺炎链球菌,差异有统计学意义(P<0.05);肺炎链球菌对青霉素MIC值0.062～2μg/ml的菌株占61.3%,MIC值≤0.062μg/ml菌株占13.0%,差异有统计学意义(χ2=69.786,P<0.05)。结论肺炎链球菌是儿童感染性肺炎优势菌,青霉素仍然为治疗普通肺炎链球菌感染的首选药物;阿莫西林、三代头孢菌素、喹奴普汀/达福普汀和氯霉素推荐用于对青霉素敏感或中介的肺炎链球菌感染;左氧氟沙星及万古霉素均有极高的敏感率,而红霉素、克林霉素及四环素的敏感率极低。

OBJECTIVE To determine the positive rate and drug resistance of Streptococcus pneumoniae isolated from the sputum. METHODS A total of 691 sputum samples were collected from the hospitalized children with infectious pneumonia in the hospital from Jan to Dec 2010. The bacteria identification and the drug susceptibility testing were performed by ATB system. RESULTS A total of 155 strains of S. pneumoniae were isolated from 691 sputum samples with the positive rate of 22.4%. The drug resistance rates of S. pneumoniae strains to penicillin, amoxicillin, cefotaxime, erythromycin, quinupristin/dalfopristin, clindamycin, tetracycline, levofloxacin, chloramphenicol, and vancomycin were 74.5%, 67. 2%, 67. 9%, 0. 7%/00, 88. 3%, 3. 6%/oo, 10. 2%, 100. 0%, 87.6 %, and 100.0 %, respectily. The drug susceptibility rate of penicillin-sensitive S. pueumoniae was significantly higher than that of the penicillin-resistant strains, the difference was statistically significant （P〈0.05）. The bacterial strains with MIC value to penicillin between 0. 062μg/ml and 2μg/ml accounted 61.3 %, obviously higher than those （13.0%） with the MIC value lower than 0. 062μg/ml,the difference was statistically significant. （X^2 = 69. 786,P〈0.05）. CONCLUSION S. pneumoniae has been the predominant bacteria causing pneumonia in the children. Penicillin remains the first choice for the treatment of the ordinary （general） S. pneumoniae infections. The old CLSI would lead to the misreport of large amount of penicillin-susceptible S. pneumoniae. Amoxicillin, third generation cephalosporins, quinupristin/dalfopristin, and chloramphenicol are recommended for the treatment of penicillin-susceptible or intermediate S. pneumoniae infections. The susceptibility rates to levofloxacin and vancomycin are very high, but the drug susceptibility rates to erythromycin, clindamycin, and tetracycline are very low.