肺炎链球菌感染的临床特征与耐药性分析

Study on clinical characteristics and drug resistance of infection

目的对我院肺炎链球菌分离株的分布特点及耐药率变迁进行分析,为临床治疗提供病原学依据。方法对2014-2018年南昌大学第二附属医院送检标本采用VITEK-2Compact鉴定分析仪,VITEKMS质谱仪、Optochin试验及胆汁溶菌试验对细菌进行鉴定;用AST-GP68药敏卡及纸片扩散法对抗菌药物进行体外药敏试验,并用E-test进行青霉素补充药敏试验,使用WHONET5.6软件分析临床特征和耐药性。结果共分离获得448株肺炎链球菌,标本主要来源于痰液标本(63.17%),脓液标本(27.68%)和血液标本(3.79%);收集标本中儿童组(<14岁)、老年组(>60岁)和14~60岁组患者肺炎链球菌分离率分别为7.36%、51.79%和40.85%;此外,春冬季检出率明显高于夏秋季,其中春、夏、秋、冬季检出率分别为30.14%、18.30%、18.97%和32.59%;分析药敏结果显示,肺炎链球菌对复方新诺明、四环素和红霉素的5年平均耐药率最高,分别为55.48%、69.56%和90.66%,对左氧氟沙星(2.05%)、头孢曲松(9.97%)和美罗培南(13.47%)的5年平均耐药率较低,未发现泰利霉素、莫西沙星、万古霉素和利奈唑胺耐药株;依据非脑膜炎口服给药折点判读显示,我院近5年分离的肺炎链球菌对青霉素耐药率均≥25.00%,不同年份肺炎链球菌对临床常见抗菌药物的耐药率略有差别。结论我院肺炎链球菌主要来源较广,以痰液为主,老年人为主要易感人群,感染好发于春冬季;肺炎链球菌对青霉素耐药性较严重,对左氧氟沙星、头孢曲松及美罗培南敏感性较高,未发现泰利霉素、莫西沙星、万古霉素和利奈唑胺耐药株。

Objective To provide an etiological basis for the clinical treatment of Streptococcus pneumoniae infection,the clinical distribution and drug resistance rate changes of Streptococcus pneumoniae from 2014 to 2018 in our hospital were statistically analyzed. Methods The non-repetitive clinical isolates of Streptococcus pneumoniae in the Second Affiliated Hospital of Nanchang University from 2014 to 2018 were collected. VITEK-2 Compact analyzer,VITEK mass spectrometer,Optochin test and bile bacteriorysis test were used for the Identification of bacteria. AST-GP68 susceptibility card was adopted for in vitro susceptibility test of bacteria,and penicillin supplementation susceptibility test was done by E-test. And the specimens of clinical isolates,clinical distribution and strain resistance were analyzed by WHONET 5.6 software. Results There were 448 strains of clinical isolates of Streptococcus pneumoniae from 2014 to 2018,mainly from sputum specimens,accounting for 63.17%. The segregation rates of Streptococcus pneumoniae in the children group(<14 years old),the elderly group (>60 years old) and the 14-60 years old group were 7.36%,51.79% and 40.85%,respectively. In addition,the detection rate in spring and winter was significantly higher than that in summer and autumn according to the distribution of Streptococcus pneumoniae,and the detection rates in spring,summer,autumn and winter were 30.14%,18.30%,18.97% and 32.59%,respectively. The resistance rates to sulfamethoxazole,tetracycline and erythromycin were the highest,with resistance rates of 55.48%,69.56% and 90.66%,respectively. As for levofloxacin(2.05%),ceftriaxone(9.97%) and meropenem(13.47%),the rate of resistance was low. At the same time,no strains resistant to telithromycin,moxifloxacin,vancomycin and linezolid were found. According to the interpretation of oral administration of non-meningitis,the resistance rate of Streptococcus pneumoniae to penicillin in our hospital was ≥25.00% in the past 5 years,and the insensitivity of Streptococcus pneumoniae isolated from sputum samples in each year to penicillin was generally higher than the total specimens. The resistance rates of Streptococcus pneumoniae to more than 10 kinds of common antibiotics in different years were fluctuated. Conclusions Streptococcus pneumoniae is mainly isolated from sputum samples in our hospital,while the main susceptible population is the elderly,and the infection is more frequence in spring and winter. The resistance rate of penicillin in our hospital was maintained at a high level. The resistance rate of levofloxacin,ceftriaxone and meropenem was maintained at a low level and no strains resistant to telithromycin,moxifloxacin,vancomycin and linezolid were found.