广东省虎门地区儿童肺炎链球菌血清型分布及耐药性监测

Serotype distribution and antimicrobial resistance of Streptococcus pneumoniae in children in Humen area

目的了解东莞虎门地区儿童肺炎链球菌的血清型分布和对抗菌药物的耐药性,评估几种疫苗,尤其是7价结合疫苗(PCV7)在本地区对肺炎链球菌的覆盖情况,并为临床合理使用抗菌药物提供依据。方法对2011年1月—2012年12月就诊肺炎患儿呼吸道标本中分离的肺炎链球菌,采用荚膜肿胀试验进行血清分型,并采用法国生物梅里埃公司的ATB STREP5肺炎链球菌板条进行药物敏感性试验。采用CLSI 2010年版标准判断结果,数据分析采用WHONET5.5软件。结果共分离到229株肺炎链球菌,主要血清型为19F146株(63.8%)、23F49株(21.4%)、6B12株(5.2%)和14型8株(3.5%)。7价疫苗(PCV7)的覆盖率为95.2%,11价疫苗(PCV11)的覆盖率为95.2%,13价疫苗(PCV13)的覆盖率为97.4%。所分离的肺炎链球菌中青霉素敏感的肺炎链球菌(PSSP)占92.6%(212/229),青霉素中介的肺炎链球菌(PISP)占5.7%(13/229),青霉素耐药的肺炎链球菌(PRSP)占1.7%(4/229)。肺炎链球菌对红霉素、克林霉素、四环素、甲氧苄啶-磺胺甲口恶唑、氯霉素、头孢噻肟、阿莫西林的耐药率依次为95.6%、93.0%、88.2%、86.5%、7.0%、2.2%、0.9%,所有菌株对万古霉素和左氧氟沙星完全敏感。结论该地区儿童肺炎链球菌的血清型主要为19F、23F、6B和14型,PCV7的覆盖率为95.2%,提示可用于本地区的预防接种。肺炎链球菌对红霉素、克林霉素、四环素、甲氧苄啶-磺胺甲口恶唑耐药严重,对万古霉素、左氧氟沙星、青霉素的敏感率较高。

Objective To investigate the serotype distribution and antimicrobial resistance of the S. pneumoniae strains isolated from children in Humen, and evaluate coverage of the serotypes by several vaccines, especially PCVT. Methods A total of 229 S. pneurnoniae strains were isolated from the children treated in our hospital during January 2011 and December 2012. Capsular typing was performed by Quellung reaction. Antimicrobial susceptibility was determined by ATB STREP 5. The data were analyzed by WHONET 5.5 software according to CLSI 2010 breakpoints. Results The main serotypes identified from the 229 S. pneurnoniae strains were 19F （146, 63.8%）, 23F （49, 21.4%）, 6B （12, 5.2%） and 14 （8, 3.5%）. The coverage of these serotypes was 95.2% by PCV7, 95.2% by PCVll, and 97.4% by PCV13. Of all the S. pneumoniae strains, penicillin susceptible S. pneumoniae （PSSP） accounted for 92.6% （212/229）, penicillin intermediate S. pneumoniae （PISP） accounted for 5.7% （13/229） and penicillin resistant S. pneumoniae （PRSP） accounted for 1.7% （4/229）. About 95.6%, 93.0%, 88.2%, 86. 5%, 7. 0%, 2. 2% and 0. 9% of the isolates were resistant to erythromycin, clindamycin, tetracycline, trimethoprim-sulfamethoxazole, chloramphenicol, cefotaxime and amoxicillin, respectively. No strain was found resistant to vancomycin or levofloxacin. Conclusions The serotypes 19F, 23F, 6B and 14 are the main prevalent serotypes of S. pneurnoniae in children in Humen. PCV7 could cover 95. 2% of these S. pneumoniae, indicating its appropriateness for vaccination in Humen area. These S. pneumoniae strains were highly sensitive to vancomycin, levofloxacin and penicillin, but relatively more resistant to erythromycin, clindamycin, tetracycline and trimethoprim-sulfamethoxazole.