呼吸道感染患者及健康儿童中耐青霉素肺炎链球菌的调查

Bacterial resistance in streptococcus pneumoniae

目的 了解肺炎链球菌在呼吸道感染患者和健康儿童中的分离率及对抗菌药物的耐药性。方法 采集呼吸道感染患者的痰、咽拭、支气管分泌物以及健康幼儿的鼻咽部标本进行肺炎链球菌培养。琼脂稀释法测定该菌对 14种抗菌药物的耐药性。结果 418份成人呼吸道感染患者标本中肺炎链球菌的分离率为 10 %左右 ;但在 791份 2～ 6岁健康儿童标本中 ,鼻腔内肺炎链球菌的分离率为 30 .2 % ,不同社区幼儿园间该菌携带率有显著差别。 82株临床分离株中仅 1株对青霉素低耐药(MIC为 0 .12 5 μg/ml) ,2 2 8株健康幼儿的肺炎链球菌 32株为青霉素低耐药 (MIC为 0 .12 5～ 0 .5 μg/ml) ,耐药率 14%左右。结论 肺炎链球菌成人分离率为 10 % ,儿童为 30 2 % ;青霉素耐药株除对氟喹诺酮类和万古霉素仍高度敏感外 ,对多数测试药物的耐药率均较敏感株显著为高 ,还出现了第三代头孢菌素的耐药株。

Objective To investigate the prevalence of Streptococcus pneumoniae in patients with respiratory tract infection and healthy children and to determine the antibiotic susceptibility in S.pneumoniae . Methods Sputum and throat swabs were collected from the adult and children patients. Nasopharyngeal specimens were collected from healthy children with aseptic swab and cultured for S.pneumoniae . Antibiotic susceptibility was determined by agar dilution method. Results The isolation rates of S.pneumoniae were 10% in both children and adult out patients, being 30.2% in 2 6 year old healthy children. Among 82 clinical isolates, only one was low level resistant to penicillin (MIC 0.125 mg/L). In 228 S.pneumoniae strains from healthy children, 32 were low level resistant to penicillin (MIC 0.125～0.5 mg/L),the resistant rate being 14.0%. S.pneumoniae was usually resistant to erythromycin, clindamycin and SMZ TMP. Conclusion The penicillin resistant strains are far more resistant to all the agents tested than susceptible strains except fluoroquinolones and vancomycin; in addition, several strains resistant to the third generation cephalosporins are found.