上呼吸道感染儿童肺炎链球菌的耐药性分析

Drug resistance of Streptococcus pneumoniae in children with upper respiratory tract infection

目的对上呼吸道感染儿童的肺炎链球菌感染情况、血清型及耐药性进行调查,为临床诊断、治疗提供数据参考。方法以2017年1月—2018年10月在徐州儿童医院就诊的上呼吸道感染儿童为研究对象,于治疗前采集鼻咽拭子,分离鉴定肺炎链球菌及其血清型,检测抗生素耐药性。结果 896份鼻咽拭子中,肺炎链球菌阳性率为19.1%,3~4岁幼儿感染率最高(24.5%),感染率高峰出现在初夏(36.9%)。所有肺炎链球菌菌株均对阿莫西林和左氧氟沙星敏感,对头孢曲松、氯霉素敏感性也较高(80%以上),但对红霉素、四环素、阿奇霉素均有较高的耐药性(均达到50%以上),多重耐药率较高(84.8%)。分离的肺炎链球菌以常见血清型为主,如6A、19F、6B、23F、14、18C型等,且以PCV7覆盖菌株和PCV13覆盖菌株为主,分别为63.2%和73.7%。对青霉素、头孢曲松、美罗培南及复方新诺明的不敏感率,PCV7覆盖菌株高于PCV7非覆盖菌株、PCV13覆盖菌株高于PCV13非覆盖菌株,差异有统计学意义(P <0.05)。结论徐州市上呼吸道感染儿童肺炎链球菌感染率较高,且以常见血清型为主,对红霉素、四环素、阿奇霉素存在较高耐药性。

Objective To investigate the infection,serotype and drug resistance of Streptococcus pneumoniae in children with upper respiratory tract infection,so as to provide reference for the diagnosis and treatment.Methods The children with upper respiratory tract infection who hospitalized in Xuzhou Children’s Hospital from January 2017 to October 2018 were selected as subjects.The nasopharyngeal swab samples were extracted,Streptococcus pneumoniae isolation,serotyping,and drug resistance were completed.Results Among 896 nasopharyngeal swab samples,the identification of Streptococcus pneumoniae was 19.1%,the children aged 3-4 year old posed the highest infection rate(24.5%).The highest infection rate of Streptococcus pneumoniae occurred in early summer(36.9%).All of the Streptococcus pneumoniae isolates were susceptible to amoxicillin and levofloxacin,and were also susceptible to ceftriaxone and chloramphenicol(80%).The isolates showed resistance to erythromycin,tetracycline and azithromycin(all over 50%),and had a higher rate of multiple resistance(84.8%).The main serotypes of Streptococcus pneumoniae were 6 A,19 F,6 B,23 F,14 and 18 C,PCV7-covered and PCV13-covered strains accounted for 63.2%and 73.7%respectively.The insensitivity rate of penicillin,ceftriaxone,meropenem and trimethoprim,PCV7-covered strains were significantly higher than PCV7-uncovered strains,and PCV13-covered strains were significantly higher than PCV13-uncovered strains(P<0.05).Conclusion Streptococcus pneumoniae in children with upper respiratory tract infection in Xuzhou was higher,most of the isolates were common serotypes.The strains showed resistance to erythromycin,tetracycline and azithromycin.