儿童呼吸道标本肺炎链球菌的耐药性监测

Surveillance of antimicrobial resistance in the Streptococcus pneumoniae strains isolated from respiratory tract of children

目的探讨广东省中山市博爱医院儿童呼吸道肺炎链球菌的感染状况和流行特征,及其对常用抗菌药物的耐药性。以期有效指导临床合理用药和预防感染。方法对2013年5月-2017年8月该院儿科门诊和住院部诊断为下呼吸道感染患儿的痰标本进行肺炎链球菌分离培养,并进行鉴定及药敏试验。结果 (1)从28 006例呼吸道感染儿童痰液检出肺炎链球菌共2 963株,检出率为10.6%;(2)肺炎链球菌感染主要多见于6岁以下患儿,冬春季为高发,多种细菌混合感染率为43.0%,以混合卡他莫拉菌和流感嗜血杆菌为多见;(3)肺炎链球菌对青霉素的不敏感率为6.0%;(4)肺炎链球菌对红霉素、克林霉素和四环素耐药率高(>90%),对氯霉素和氧氟沙星的敏感率在95%以上,未检出对利福平、利奈唑胺和万古霉素耐药的菌株。结论儿童呼吸道肺炎链球菌的感染与年龄、季节有关,呈逐年递增趋势,合并多种细菌混合感染率较高。青霉素不敏感肺炎链球菌比例较高。对红霉素、克林霉素和四环素的耐药率都在95%以上,表现为多重耐药。儿童中检出的肺炎链球菌对抗生素的耐药状况已很严峻,临床诊疗要密切监测肺炎链球菌感染的流行病学特点及耐药情况,及时调整经验用药方案和预防感染策略。

Objective To investigate the antimicrobial resistance profile of the Streptococcus pneumoniae strains isolated rom respiratory tract of children in Zhongshan Boai Hospital, Guangdong Province for better management of such infections. ethods The sputum samples were collected from respiratory tract of children in pediatric outpatient and inpatient from May 2013 o August 2017. S. pneumoniae strains were isolated and identified and their susceptibility to antimicrobial agentswas determined.Results The prevalence of S. pneumoniae was 10.6% （2 963/28 006） in the sputum samples. S. pneumoniae was mainly isolated rom children under 6 years old, and relatively higher in winter and spring. About 43.0% of the S. pneumoniae isolates was associated ith mixed infection, especially Moraxella catarrhalis and Haemophilus influenzae. About 6.0% of the S. pneumoniae isolates were on-susceptible to penicillin, 59.3% non-susceptible to ceftriaxone, and more than 95% non-susceptible to erythromycin, clindamycin or tetracycline. However, more than 95% of the isolates were susceptible to chloramphenicol or ofloxacin. No S. pneumoniae isolate was found resistant to rifampin, linezolid or vancomycin. Conclusions The respiratory tract infection caused by S. pneumoniae of children is increasing year by year, which is associated with age, season, and higher rate of mixed infection. These data showed that penicillin non-susceptible S. pneumoniae is highly prevalent in Zhongshan. More than 95% of the S. pneumoniae isolates from children are resistant to erythromycin, clindamycin or tetracycline. S. pneumoniae isolates should be closely monitored for the emergence of multidrug resistant strains.Appropriate control measures must be taken according to the esults of susceptibility testing.