2015-2019年儿童呼吸道感染嗜血杆菌分离检出及耐药性变迁分析

Detection and Drug Resistance of Haemophilus in Children’s Respiratory Tract Infection

目的探讨儿童呼吸道嗜血杆菌的感染情况及耐药性变迁,为临床合理用药提供参考。方法对2015年1月~2019年12月儿科门诊就诊及住院患儿痰标本中分离的233株嗜血杆菌属细菌的临床感染特征及药敏试验结果进行回顾性分析。结果嗜血杆菌的总检出率为5.1%(233/4575),其中副流感嗜血杆菌51.1%(119/233),流感嗜血杆菌36.9%(86/233),溶血嗜血杆菌6.4%(15/233)、惰性嗜血杆菌3.0%(7/233)和嗜沫嗜血杆菌2.6%;流感嗜血杆菌和副流感嗜血杆菌对氨苄西林和复方新诺明耐药率均超过60%,耐药率呈逐年上升趋势;对头孢哌酮/舒巴坦及第三、四代头孢菌素、左氧氟沙星、亚胺培南和阿奇霉素敏感率均大于70%;总β-内酰胺酶阳性率为44.9%,产酶株全部对氨苄西林耐药,产酶阴性株中氨苄西林耐药率为22%。结论嗜血杆菌在儿童呼吸道标本中的检出率较高,对临床常用抗菌药物耐药率呈逐年上升趋势,临床应根据药敏试验数据合理应用抗生素才能减缓耐药菌株产生。

Objective To explore the infection characteristics and drug resistance of Haemophilus in children’s respiratory tract in their hospital from January 2015 to December 2019.Methods The infection characteristics of 233 Haemophilus isolated from sputum samples of outpatients and inpatients in pediatrics were summarized and the antimicrobial sensitivity test results were analyzed.Results The total detection rate of Haemophilus was 5.1%,including Haemophilus parainfluenzae 51.1%(119/233),Haemophilus influenzae 36.9%(86/233),Haemophilus haemolyticus 6.4%(15/233),Haemophilus inert 3.0%(7/233)and Haemophilus foamus 2.6%(6/233).The drug resistance rate of Haemophilus influenzae and Haemophilus parainfluenzae to ampicillin and compound sulfamethoxazole was more than 60%,and the drug resistance rate showed an increasing trend year by year.The sensitivity rate of Haemophilusinfluenzae to Cefoperazone/sulbactam,third and fourth generation cephalosporins,levofloxacin,imipenem and azithromycin was more than 70%.The positive rate of totalβ-lactamase was 44.9%,and all the positive strains were resistant to ampicillin.Among the negative strains ofβ-lactamase,the drug resistant rate to ampicillin was 22%.Conclusion The detection rate of Haemophilus in children’s respiratory tract specimens was high,and the resistance rate to commonly used antibiotics was increasing year by year.The rational use of antibiotics should be based on the data of drug sensitivity test to slow down the production of bacterial resistance.