医院感染与社区感染肺炎链球菌分布与耐药性分析

Distribution and resistance of Streptococcuspneumoniaecausing hospital and community-acquired infections

目的分析医院感染与社区感染肺炎链球菌的耐药性差异,为临床治疗肺炎链球菌感染提供参考依据。方法对2011年6月-2014年4月临床感染标本中分离的肺炎链球菌140株比较分析,用VITEK-2Compact及VITEK GP鉴定卡鉴定,药敏试验用K-B法,数据采用SPSS 19.0软件进行统计分析。结果分离的肺炎链球菌对青霉素G、苯唑西林、克林霉素、红霉素、阿奇霉素的耐药率分别为46.43%、76.43%、87.14%、92.14%、89.29%;医院感染与社区感染肺炎链球菌对青霉素G、苯唑西林、红霉素、阿米卡星、环丙沙星等抗菌药物耐药率分别为70.77%与25.33%、93.85%与61.33%、98.46%与86.67%、100.00%与66.67%、10.77%与0;医院感染肺炎链球菌耐率高于社区感染肺炎链球菌,差异有统计学意义(P<0.05)。结论肺炎链球菌对常用抗菌药物耐药率持续升高,特别是医院感染升高尤为明显,临床医师应引起重视,加强监测临床感染菌的药敏变化,及时监测细菌的耐药性,有针对性地选用敏感性强的抗菌药物,接种肺炎链球菌疫苗等,有效控制和减缓细菌耐药性的增长。

OBJECTIVE To compare the differences in resistance of Streptococcus pneumoniae causing hospital in- fections and community-acquired infections, so as to provide reference for the clinical treatment of S. pneumoniae infections. METHODS A comparative analysis was conducted on 140 clinical strains of S. pneumoniae isolated from clinical infection specimens during Jun. 2011 to Apr. 2014. The strains were identified by VITEK-2 Com- pact and VITEK GP identification card. The Kirby-Bauer method was used for drug sensitivity test. The SPSS 19.0 software was used for statistical analysis. RESULTS The resistance of isolated S. pneumoniae to penicillin G, oxacillin, clindamycin, erythromycin, azithromycin was respectively 46.43%, 76.43%, 87. 14%, 92.14%, 89.29%. The drug resistance rate of hospital infections and community-acquired infections to penicillin G, oxacil- lin, erythromycin, amikacin and ciprofloxacin was respectively 70.77%, 25.33% ; 93.85%, 61.33% ; 98.46%, 86.67% ; 100.00%, 66.67% ; 10.77%, O. The resistance rate of S. pneumoniae was significeatly higher for hos- pital infections than for community-acquired infections （P〈0.05）. CONCLUSION The resistance rate of S. pneu- moniae to commonly used antimicrobial drugs continues to rise, especially for hospital infection. Clinicians should pay attention to strengthening drug sensitivity monitoring and the changes of clinical infection bacteria as well as bacterial resistance, make targeted selection of drugs with high sensitivity, perform inoculation of S. pneurnoniae vaccine, so as to effective control and slow down the increase of bacterial resistance.