2013-2014年泉州地区肺炎链球菌感染的分布及耐药性分析

Infection distribution and drug resistance analysis of Streptococcus pneumonia isolated from Quanzhou in 2013-2014

目的了解泉州地区2013-2014年临床分离的肺炎链球菌(Streptococcus pneumoniae,SP)的感染情况及耐药性特点,为临床合理使用抗菌药物提供依据。方法回顾性分析福建医科大学附属泉州市第一医院和福建医科大学附属二院2013-2014年医院分离到的661株SP的临床资料,并对细菌的耐药性进行统计分析。结果 SP分离株主要标本来源为痰液和血液,占86.82%和4.67%;SP分离株主要来源于儿科等相关专业科室;感染的人群主要为5岁以下儿童及50岁以上的老年人。SP对红霉素、克林霉素、四环素、复方新诺明、青霉素、头孢噻肟、头孢吡肟、美洛培南、阿莫西林、氯霉素、左旋氧氟沙星的耐药率分别99.2%、95.6%、85.3%、75.0%、25.7%、41.2%、35.8%、22.8%、21.5%、12.4%、4.4%,对替考拉宁、利奈唑胺、万古霉素的敏感率均为100%。耐药谱分析发现SP主要表现出对红霉素-克林霉素-四环素-复方新诺明耐药,占41.61%,而且耐5种及5种以上抗生素的菌株各占19.94%和18.31%;青霉素耐药的菌株同时表现出对红霉素、克林霉素、四环素、复方新诺明的耐药,青霉素耐药与敏感菌株在复方新诺明、头孢噻肟、头孢吡肟、美洛培南组间耐药率比较差异均具有统计学意义(P<0.05)。结论临床感染SP主要人群以5岁以下的儿童及50岁以上的老年人,临床分离的菌株更多的表现为多重耐药,应进一步规范临床抗菌药物的使用。

Objective To analyze the clinical infection feature and drug resistance of Streptococcus pneumonia（SP） isolated from Quanzhou region in 2013-2014, and to provide evidence for clinical use of antibiotics.Methods The clinical data of 661 SP strains from Quanzhou First Hospital Affiliated to Fujian Medical University and the Second Affiliated Hospital of Fujian Medical University from 2013 to 2014 were retrospectively analyzed.And the bacterial drug resistance was analyzed by statistical method. Results SP strains were mostly isolated from specimens of sputum and blood, and the constituent ratios were 86.82% and 4.67%, respectively. The SP isolates mainly distributed in Department of Pediatrics and the related departments. Infected people were mainly children under 5years old and the elderly over the age of 50. The resistance rates of SP to erythromycin, clindamycin, tetracycline, cotrimoxazole, penicillin, cefotaxime, cefepime, meropenem, amoxicillin, chloramphenicol, ofloxacin were 99.2%,95.6%, 85.3%, 75.0%, 25.7%, 41.2%, 35.8%, 22.8%, 21.5%, 12.4%, 4.4%, respectively, and the susceptibility rates to teicoplanin, linezolid, vancomycin were all 100%. SP strains were mostly resistant to erythromycin, clindamycin, tetracycline, cotrimoxazole simultaneously, with the positive rate of 41.61%. The constituent ratios of SP strains resistant to five and more drugs were 19.94% and 18.31%, respectively. The SP strains resistant to penicillin also showed resistance to erythromycin, clindamycin, tetracycline, cotrimoxazole. There was statistically significant differences between the penicillin-resistant strains and penicillin-sensitive strains in the resistance to cotrimoxazole, cefotaxime, cefepime, meropenem（P〈0.05）. Conclusion The SP strains are mainly isolated from children under 5 years old and the elderly over the age of 50, which mostly show multi-drug resistance. Appropriate antibiotics should be selected for the treatment of infection according to drug sensitivity.