致儿童下呼吸道感染肺炎链球菌分离株的临床特征及药敏分析

Clinical features and drug sensitivity of lower respiratory tract infection induced by Streptococcus pneumoniae in children

目的分析下呼吸道感染患儿肺炎链球菌(SP)分离株的临床特征及其对常用抗生素的药敏情况,为临床合理用药提供依据。方法采用回顾性分析法,收集2008年1月到2012年12月自下呼吸道感染患儿分离的SP 6 358株,采用纸片扩散法及E-test法进行抗菌药物敏感试验;按CLSI判断标准分析药敏结果。结果 SP分离株主要来自于儿内科各专业科室,感染病例以各类肺炎和支气管炎为主。在分离的6 358株SP中,青霉素、头孢噻肟、红霉素、克林霉素、复方新诺明、四环素、氯霉素、左氧氟沙星、万古霉素的耐药率分别为5.0%、12.9%、98.7%、96.0%、92.2%、7.3%、5.6%、0.2%、0.0%;青霉素与头孢噻肟的年耐药率差异均有统计学意义(P均<0.05)。318株耐青霉素SP对上述药物的耐药率分别为100.0%、42.6%、100.0%、100.0%、99.2%、23.6%、6.8%、0.6%、0.0%,青霉素与头孢噻肟间比较,耐药率差异有统计学意义(P=0.001)。结论下呼吸道感染患儿分离的SP对红霉素、克林霉素、复方新诺明及四环素的耐药率较高,对头孢噻肟的耐药率呈逐年递增的趋势,临床应依据药敏结果选择合适的抗菌药物。

Objective To explore clinical features and drug sensitivity of Streptococcus pneumoniae（SP） isolated from pediatric patients with lower respiratory tract infection,and to provide evidence for clinical use of antibiotics.Methods A total of 6 358 clinical SP isolates from children with lower respiratory tract infection from January 2008 to December 2012 were collected and retrospectively analyzed.The antibiotic sensitivity was done by Kirby-Bauer method and E-test,and all results were in strict accordance with the rules of CLSI.Results The isolated SP strains were mainly from different departments of pediatrics.All clinical cases with SP infection mainly included pneumonia and bronchitis.The resistance rates of 6 358 SP strains to penicillin,cefotaxime,erythromycin,clindamycin,cotrimoxazole,tetracycline,chloramphenicol,levofloxacin,vancomycin were 5.0%,12.9%,98.7%,96.0%,92.2%,7.3%,5.6%,0.2% and 0.0% respectively,and the resistance rate to penicillin and cefotaxime was significantly different in every years（all P＆lt;0.05）.The resistance rates of the 318 penicillin-resistant SP strains to the above antibiotics were 100.0%,42.6%,100.0%,100.0%,99.2%,23.6%,6.8%,0.6%,0.0% respectively,and the resistance rate to penicillin and cefotaxime was significantly different（P=0.001）.Conclusions The antibiotic resistance rates of SP strains isolated from children with lower respiratory tract infection were higher to erythromycin,clindamycin,cotrimoxazole and tetracycline,and an increasing rate in drug resistance to cefotaxime was observed in recent years.Appropriate antibiotics should be selected for the treatment of infection according to drug sensitivity.