河南省220所医院肺炎链球菌分布及药物敏感性监测

Distribution and Drug Susceptibility Monitoring of Streptococcus pneumoniae in 220 Hospitals in Henan Province

目的了解河南省141家二级医院和79家三级医院临床分离的肺炎链球菌分布特点及耐药情况,为各级医院临床抗感染治疗提供依据。方法收集2019年—2021年临床分离非重复肺炎链球菌菌株,采用自动化仪器和E试验条法进行药物敏感性试验,按美国临床和实验室标准化协会(CLSI)2022年版标准判读结果。采用Whonet 5.6及Spss 26.0软件进行数据统计分析。结果共分离肺炎链球菌15480株,主要来自痰液(78.1%)、血液(6.7%),患者集中在儿科(40.5%),冬季占比最高(46.1%)。未检出耐万古霉素和利奈唑胺的肺炎链球菌;随年龄增长氯霉素敏感率呈下降趋势,脑脊液菌株中PSSP检出率32%,非脑脊液菌株PSSP检出率>92%,二级医院菌株敏感率普遍低于三级医院,差异有统计学意义(P<0.001)。结论肺炎链球菌多检自冬季儿科患者的痰液标本。青霉素和头孢曲松仍可作省内儿童抗感染治疗的首选,成人还可备选左氧氟沙星。青霉素不再适合脑膜炎的抗感染治疗。各级医院应提升检测能力,以期获得准确药敏结果。

Objective In Henan province,Streptococcus pneumoniae isolates from 141 secondary hospitals and 79 tertiary hospitals were studied to better understand their medication resistance and distribution patterns.This information will serve as a foundation for clinical anti-infection treatment in hospitals across the board.Methods Collect non-repetitive Streptococcus pneumoniae strains clinically isolated from 2019 to 2021,conduct drug sensitivity tests using automated instruments and the E-test strip method,and interpret the results according to the American Clinical and Laboratory Standardization Institute(CLSI)2022 standard.Data statistical analysis was conducted using Whonet 5.6 and Spss 26.0 software.Results A total of 15480 strains of Streptococcus pneumoniae were isolated,mainly from sputum(78.1%)and blood(6.7%).Pediatric patients made up the majority of the patient population(40.5%),with winter accounting for the largest percentage(46.1%);no evidence of vancomycin or linezolid-resistant Streptococcus pneumoniae was found;the sensitivity rate to chloramphenicol falls with age,with 32%of strains in cerebrospinal fluid being detected for PSSP and 92%of strains in non-cerebrospinal fluid.The sensitivity rate of strains in secondary hospitals is generally lower than that in tertiary hospitals,and the difference is statistically significant(P<0.001).Conclusion Streptococcus pneumoniae is mostly detected in sputum samples of pediatric patients in winter.Penicillin and ceftriaxone can still be the first choice for anti-infection treatment in children within the province,and levofloxacin can also be used as an alternative for adults.Penicillin is no longer suitable for anti-infective treatment of meningitis.Hospitals at all levels should enhance their testing capabilities in order to obtain accurate drug sensitivity results.