广州某三级医院无乳链球菌临床感染情况及耐药性分析

The status of Streptococcus agalactiae infection and drug resistance in our hospital from 2016 to 2018

目的探讨某三级医院无乳链球菌感染中各病区的阳性率及近三年来抗生素耐药变化情况,为临床治疗无乳链球菌感染的合理用药提供依据。方法以广州医科大学附属第五医院2016年1月至2018年12月门诊及住院患者细菌培养分离的无乳链球菌菌株353例为研究对象,其中2016年度无乳链球菌标本118份,2017年度无乳链球菌标本153份,2018年度无乳链球菌标本82份,均经VITEK-2 Compact全自动微生物鉴定药敏分析仪鉴定,经肉汤稀释法测得无乳链球菌对常见抗生素的药敏情况,采用WHONET 5.6软件对常用抗生素敏感性试验结果进行数据分析。结果353份无乳链球菌标本主要来源于阴道分泌物和宫颈分泌物,妇科为无乳链球菌标本分布最多的临床科室,分别为2016年度34.75%(41/118)、2017年度41.18%(63/153)、2018年度47.56%(39/82);其次是产科和泌尿外科。无乳链球菌药物敏感性试验结果显示,耐药率最高的为四环素,最高耐药率91.5%,对红霉素、克林霉素、环丙沙星、左旋氧氟沙星耐药率较高,分别是72.0%~77.1%、61.9%~66.7%、23.7%~28.0%、22.9%~25.6%,未发现对万古霉素、青霉素、利奈唑胺、替加环素耐药的菌株。结论无乳链球菌临床分布以妇科、产科和泌尿外科为主,其对四环素类和大环内酯类抗生素的耐药率较高,应重视对围产期妇女无乳链球菌预防性筛查工作。

Objective To investigate the infection rate and drug resistance of Streptococcus agalactiae in our hospital,and provide evidence for rational drug use in clinical treatment of Streptococcus agalactiae infection.Methods 353 strains of Streptococcus agalactiae isolated from outpatients and inpatients in the Fifth Affiliated Hospital of Guangzhou Medical University from January 2016 to December 2018 were collected and studied.Among them,118 strains of Streptococcus agalactiae were isolated in 2016,153 strains in 2017 and 82 strains in 2018 were isolated and identified by VITEK-2 Compact system.The susceptibility of Streptococcus agalactiae to common antibiotics was determined by MIC method.The results of susceptibility test of common antibiotics were analyzed by WHONET 5.6 software.Results The 353 specimens of Streptococcus agalactiae were mainly derived from vaginal secretions and cervical secretions.Gynecology is the clinical department with the largest distribution of Streptococcus agalactia specimens,which were 34.75%(41/118)in 2016 and41.18%(63/153)in 2017 and 47.56%(39/82)in 2018,followed by obstetrics and urology.The resistance rate of Streptococcus agalactiae isolates to tetracycline was the highest 91.5%,followed by erythromycin,clindamycin,ciprofloxacin and levofloxacin(72.0%-77.1%,61.9%-66.7%,23.7%-28.0%,22.9%-25.6%,respectively).There was no strain found to be resistant to vancomycin,penicillin,linezolid and teicoplanin.Conclusion s The clinical distribution of Streptococcus agalactiae is mainly in gynecology,obstetrics and urology department.The resistance rate of Streptococcus agalactiae to tetracycline and macrolide antibiotics is high.We should pay attention to the preventive screening of Streptococcus agalactiae in perinatal women.