玉溪市2014年至2016年儿童肺炎链球菌感染流行情况及耐药性分析

Prevalence and Drug Resistance of Streptococcus Pneumoniae Infection in Children in Yuxi during from 2014 to 2016

目的了解云南省玉溪市2014年至2016年肺炎链球菌(SPN)流行及其耐药情况,为临床合理用药提供依据.方法采用回顾性分析方法,收集2014年1月至2016年12月玉溪市儿童医院住院患儿326份SPN菌株,并进行统计学分析.对3个年度分离情况,以及不同年龄、不同性别、不同季节的感染情况进行分析,采用法国梅里埃公司的VITEK2细菌鉴定及药敏系统进行抗菌药物敏感试验,按CLSI判定标准分析药敏结果.结果玉溪市儿童SPN感染呈逐年上升趋势,在分离的326株SPN中以1岁以下婴幼儿为主(62.3%),男孩居多(63.2%),从季节分布看,冬季(10~12月)较易感染(50.9%).SPN对万古霉素、头孢吡肟、阿莫西林/克拉维酸、利奈唑胺、泰利霉素敏感率均为100%,对头孢曲松、头孢噻肟的耐药率有所上升,对青霉素的耐药率有所下降,对克林霉素、克拉霉素、红霉素、阿齐霉素的耐药率极高.结论玉溪市儿童SPN感染呈明显上升趋势,冬季发病率较高,以1岁以下婴幼儿较易感染并以男孩居多.青霉素、阿莫西林/克拉维酸、及第3、4代头孢菌素可作为治疗SPN感染的首选药物;克林霉素、克拉霉素、红霉素和阿奇霉素不能用于SPN感染治疗;未发现对万古霉素耐药菌株.建议临床参考本地流行病学资料,依据药敏结果合理用药.

Objective To learn the prevalence and drug resistance of Streptococcus pneumoniae（SPN） in children in Yuxi from 2014 to 2016,and to provide the basis for clinical rational drug use.Methods We made a retrospective analysis of 326 children with SPN,a strain collected from January 2014 to December 2016 in Yuxi city children＇s Hospital,and statistical analysis.The infection condition was analyzed in the recent three years,in different season and in children with different age and different gender.The antimicrobial susceptibility test was performed by VITEK2 bacterial identification and susceptibility system of France bio Merieux company,according to the CLSI criteria of drug sensitivity analysis results.Results Children＇s SPN infection of Yuxi increased year by year,mainly in infants under one year of age in the 326 strains of SPN（62.3%）,most of them were boys（63.2%）,from the seasonal distribution,winter（10-12 months） than the susceptible（50.9%）.SPN to vancomycin and cefepime,amoxicillin/clavulanate,linezolid.Telithromycin sensitive rate was 100%,to ceftriaxone,cefotaxime resistance rate increased,the resistant rate of penicillin decreased,The resistance rate of clindamycin,clarithromycin,erythromycin and Azithomycinwas was extremely high.Conclusions The prevalence of SPN infection in children in Yuxi increased obviously,and the incidence rate was higher in winter.The infants under one year old were more susceptible to infection and the majority were boys.amoxicillin/clavulanate,and three or four generation cephalosporins can be used as the preferred drug for the treatment of SPN infection;penicillin,clindamycin,clarithromycin,erythromycin and azithromycin can not be used for the treatment of SPN infection;to vancomycin resistant strains.It is suggested that local epidemiological data should be taken for rational use of the drug according to the results of drug sensitivity.