海口地区儿童感染流感嗜血杆菌的分布情况及耐药性分析

Distribution of Haemophilus Influenzae in Affected Children in Haikou Area and Its Antimicrobial Resistance Analysis

目的了解海口地区患儿感染流感嗜血杆菌的分布情况及其耐药性，为临床合理使用抗菌药物提供依据。方法收集海口地区2010-2011年住院患儿2730份临床送检标本中分离的不重复流感嗜血杆菌158株，用头孢硝噻吩（Nitroeefin）纸片法测定其β-内酰胺酶；药敏试验采用纸片扩散法（K—B法），结果按临床实验室标准协会（CLSI）2010年版标准判读，采用WHONET5．6软件进行耐药性分析。结果158株流感嗜血杆菌主要分离自痰标本125株（占79．1％）；其次为咽拭子18株（占11．4％）、脑脊液5株（占3．2％）、血培养4株（占2．5％）、其他标本6株（占3．8％）。β-内酰胺酶检测阳性率为9．5％（15／158），氨苄西林的耐药率为10．8％（17／158）；其中产β-内酰胺酶株对氨苄西林全部耐药，非产β-内酰胺酶株中有2株对氨苄西林显示耐药，但两种方法对氨苄西林的耐药性检出差异无统计学意义（Х^2=0．15，P〉0．05）。该菌对复方新诺明的耐药率高达74．1％，对其他常用抗菌药物的耐药率均在10％左右。结论流感嗜血杆菌在呼吸道标本中分离率最高，复方新诺明已不能用于该菌引起的感染治疗，氨苄西林、阿莫西林／克拉维酸、头孢呋辛、头孢他啶、左氧氟沙星、阿奇霉素对该菌具有较高的抗菌活性，可作为临床治疗的首选药物。

Objective To investigate the distribution of Haemophilus influenza （Hi） in affected children in Haikou area and its antimicrobial resistance so as to provide evidence for clinically reasonable use of antibiotics. Methods A total of 158 strains of Hi were identified from 2 730 specimens of hospitalized children in Haikou area from 2010 to 2011, Nitrocefin discs test was performed for the detection of β - Lactamase, and Kirbry - Bauer （ K -B） method was taken for the antibiotic sensitivity test. The results were analyzed according to the CLSI -2010 standard, and the WHONET 5.6 software was applied for analysis of antimicrobial resistance. Results Of the 158 strains of Hi, 125 strains （79.1% ） were isolated from sputum specimen, 18 strains （ 11.4% ） from throat swab specimen, 5 strains （ 3.2% ） from cerebrospinal fluid, 4 strains （ 2. 5 % ） from blood culture, and 6 strains （3.8%） from the other specimen. The positivity rate of β - lactamase was 9. 5% （15/158）. The rate of re- sistance against Ampicillin was 10. 8% （17/158）. All the β - lactamase - producing strains resisted to Ampicillin, but only two of the non - β - lactamase - producing strains did so, with a significant difference （X^2 = 0. 15, P 〉 0.05 ）. The antimicrobial resistance rate of Hi was 74. 1% to Sulfamethoxazole Compound, and about 10% to other antibiotics. Conclusion The detection rate of Hi is the highest in respiratory tract specimen, Sulfamethoxazole Compound can no longer be applied for Hi infection. However, AmpiciUin, Amoxicillin/Clavulanic Acid, Cefuroxime, Ceftazidime, Levofloxacin, and Azithromyxin have a high antimicrobial activity against Hi, so that they can be chosen as the initial drugs clinically.