儿童呼吸道感染流感嗜血杆菌耐药分析

Analysis of drug resistance of Haemophilus influenzae in children with respiratory tract infection

目的研究我院2014~2017年儿童呼吸道感染流感嗜血杆菌(Hi)对常用抗生素的敏感性、产β-内酰氨酶阳性率,为儿科临床合理用药提供依据。方法对2014~2017年我院儿童呼吸道感染的临床标本进行流感嗜血杆菌分离培养,用VITEK MS及VITEK 2COMPACT流感嗜血杆菌进行9种抗生素的耐药分析,采用β-内酰胺酶快速检测试剂盒检测β-内酰胺酶。结果 2014~2017年我院儿童呼吸道感染流感嗜血杆菌产β-内酰氨酶阳性率由10.00%上升至43.91%,产β-内酰氨酶阳性率明显增高(P<0.001);流感嗜血杆菌对头孢克洛、复方新诺明耐药率分别由35.56%、52.22%均上升至100%,存在明显耐药(P<0.001),对氯霉素、阿莫西林/棒酸、头孢呋辛、氨苄西林耐药率分别由2.96%、12.59%、25.56%、48.52%上升至10.90%、65.71%、84.62%、83.97%,存在明显耐药(P<0.001或P<0.01)。对头孢噻肟、氧氟沙星的耐药率,未见明显差异,近3年无明显耐药,对四环素耐药率总体比较低,耐药最高的2015~2016年也只有2.80%。结论流感嗜血杆菌耐药形势严峻,流感嗜血杆菌对头孢克洛、氨苄西林、复方新诺明、头孢呋辛耐药率明显升高,对头孢噻肟、氧氟沙星、四环素有较高的敏感性。

Objective To study the sensitivity of Haemophilus influenzae（Hi）to commonly use antibiotics and the positive rate of the producingβ-lactamases in children with respiratory tract infection treated in our hospital from 2014 to 2017 so as to provide evidences for clinical rational drug use in pediatrics. MethodsHaemophilus influenzae was isolated and cultured from clinical specimens collected from children with respiratory tract infection treated at our hospital from 2014 to 2017.VITEK MS and VITEK 2 COMPACT were used to analyze the drug resistance of Haemophilus influenzae to 9 antibiotics.β-lactamases were detected byβ-lactamase rapid detection kit. Results The positive rate ofβ-lactamase produced by Haemophilus influenzae increased from 10.00%to 43.91%in children with respiratory tract infection treated in our hospital from 2014 to2017,and the positive rate of producingβ-lactamase was significantly increased（P〈0.001）.The drug resistance rates of Haemophilus influenzae to cefaclor and compound sulfamethoxazole increased from 35.56% and52.22%to 100% and 100%respectively,and there were obvious drug resistances（P〈0.001）.The drug resistance rates of Haemophilus influenzae to chloramphenicol,amoxicillin/clavulanate,cefuroxime and ampicillin increased from 2.96%,12.59%,25.56%,48.52%to 10.90%,65.71%,84.62%and 83.97%respectively,and there were obvious drug resistances（P〈0.001 or P〈0.01）.There was no significant difference between the drug resistance rates of Haemophilus influenzae to cefotaxime and to ofloxacin,and there was no obvious drug resistance in recent three years.The overall resistance rate of Haemophilus influenzae to tetracycline was relatively low,and the highest resistance rate of Haemophilus influenzae to tetracycline was 2.80%from2015 to 2016. Conclusion The drug resistance of Haemophilus influenzae is severe.The drug resistance rates of Haemophilus influenzae to cefaclor,ampicillin,compound sulfamethoxifen and cefuroxime increased significantly,and Haemophilus influenzae has high sensitivity to cefotaxime,ofloxacin and tetracycline.