2013～2017年海南医学院第二附属医院无乳链球菌的临床分布及耐药性分析

Clinical distribution and drug resistance of Streptococcus agalactiae from 2013 to 2017 in the Second Affiliated Hospital of Hainan Medical University

目的探讨无乳链球菌的临床分布和耐药性,为预防临床感染和指导临床合理用药提供依据。方法收集2013年1月~2017年12月海南医学院第二附属医院门诊及住院患者各类临床标本。采用WHONET 5.6软件统计分析无乳链球菌引起感染的类型和耐药性,并对红霉素耐药、克林霉素敏感或中介的无乳链球菌做D-抑菌圈试验。结果共检出无乳链球菌261株,检出率逐年呈上升趋势。其主要集中分布于妇产科、门诊和泌尿外科。主要来源于阴道分泌物,其次是清洁中段尿和伤口分泌物。无乳链球菌对青霉素、氨苄西林、万古霉素和利奈唑胺均未发现耐药株;对头孢噻肟、对头孢吡肟和头孢曲松的耐药率较低;而对克林霉素、红霉素、阿奇霉素、四环素耐药率较高。结论无乳链球菌感染最常见于泌尿生殖系统感染和软组织感染,青霉素和其他β-内酰胺类药物可作为无乳链球菌感染经验用药的首选药物。另外,加做D-抑菌圈试验可有效避免不合理使用克林霉素,并根据药敏试验结果合理选用抗菌药物进行预防与治疗。

Objective To investigate the clinical distribution and drug resistance of Streptococcus agalactiae, and to provide evidence for preventing clinical infection and guiding clinical rational drug use. Methods All kinds of clinical specimens were collected from outpatient and inpatient patients of the Second Affiliated Hospital of Hainan Medical College from January 2013 to December 2017. WHONET 5.6 software was used to statistically analyze the types of infection and drug resistance caused by Streptococcus agalactiae, and to conduct the D-Bacteriostatic circle test for Streptococcus agalactiae with Erythromycin resistance, Clindamycin sensitivity or intermediate. Results A total of 261 strains of Streptococcus agalactiae were detected, and the detection rate was increasing year by year. Mainly distributed in obstetrics and gynecology, outpatient and urology. Mainly from vaginal secretions, followed by cleaning midstream urine and wound secretions. No resistant strains to Penicillin, Ampicillin, Vancomycin and Linezolid were found. The drug resistance rates of Cefotaxime, Cefepime and Ceftriaxone were low. And Clindamycin, Erythromycin, Azithromycin, Tetracycline resistance rate were high. Conclusion Streptococcus agalactiae infections are most common in urinary and reproductive system infections and soft tissue infections, and Penicillin and other β-lactamides can be used as the first choice of empiric agents for Streptococcus agalactiae infections. In addition, the addition of D-circle test can effectively avoid the unreasonable use of Clindamycin, and according to the drug sensitivity test results, the rational selection of antimicrobial agents for prevention and treatment.