侵袭性肺炎链球菌血清型和耐药性分析

Analysis of serotype and drug resistance of invasive Streptococcuspneumoniae

目的 了解河北省侵袭性肺炎链球菌血清型变迁和耐药情况,为病原菌监测及抗生素应用提供依据。方法 针对实验室收集到的2017-2018年监测菌株,使用多重聚合酶链式反应对菌株进行血清分型,使用微量营养肉汤稀释法进行药敏试验,对结果综合分析。结果 位于前三位的血清型是14型15株(20.27%)、6型11株(14.86%)、19F型10株(13.51%),19A和23F型并列第四位均为6株(8.11%)。12种抗生素中,万古霉素和左氧氟沙星未发现耐药菌株,其余抗生素均有耐药菌株出现。耐药率>90.00%的抗生素为红霉素和克林霉素;敏感率>80.00%的抗生素包括利福平、头孢吡肟、头孢噻肟、美罗培南、氯霉素;青霉素敏感率为50.00%。87.84%的菌株为多重耐药菌株。相对于整体水平,14型对多西环素耐药率较低,19F型对头孢噻肟和美罗培南耐药率较高。结论 本地区肺炎链球菌的优势血清型由早期报道的19F、19A、6、14和1型转变为14、6、19F、19A和23F型。建议制定动态监测方案,及时预警。治疗由肺炎链球菌引起的感染首选头孢噻肟、头孢吡肟、美罗培南、利福平。红霉素、克林霉素单耐药和多重耐药均较严重。多重耐药菌株比例较大。

Objective To understand the serotype changes and drug resistance of invasive Streptococcus pneumoniae in Hebei Province,so as to provide suggestions for pathogenic bacteria monitoring and antibiotic application.Methods The surveillance strains from 2017 to 2018 were collected in the laboratory.Multiplex polymerase chain reaction was used for serotyping of the strains,and micronutrient broth dilution method was used for drug susceptible test.The results were analyzed comprehensively.Results The top three serotypes were 15 strains of type 14(20.27%),11 strains of type 6(14.86%),10 strains of type 19F(13.51%),19A and 23F were both ranked fourth with 6 strains(8.11%).Among the 12 antibiotics,no drug-resistant strains has been found in vancomycin and levofloxacin.Antibiotic resistant strains appeared in all other antibiotics.Erythromycin and clindamycin were the antibiotics with drug resistance rate greater than 90.00%.Those with sensitivity rate>80.00%included rifampicin,cefepime,cefotaxime,meropenem and chloramphenicol.The sensitivity rate of penicillin was only 50.00%.Eighty-seven point eighty-four percent of the strains were multidrug resistant.The resistance rates of type 14 to doxycycline was lower than the overall level.On the contrary,the resistance rates of type 19F to cefotaxime and meropenem were higher.Conclusion n The dominant serotypes of Streptococcus pneumonia in this area have changed from the earlier reported types 19F,19A,6,14 and 1 to 14,6,19F,19A and 23F.It is suggested to develop a dynamic monitoring program for early warning.Cefotaxime,cefepime,meropenem and rifampicin are the first choice for the treatment of infection caused by Streptococcus pneumoniae.The single drug resistance and multiple drug resistance of erythromycin and clindamycin are both serious.The proportion of multidrug resistant strains is larger.