北京地区呼吸道感染患儿卡他莫拉菌携带情况及耐药性分析

Analysis of nasopharyngeal carriage and antibiotic resistance of Moraxella catarrhalis in children with respiratory tract infection in Beijing

目的 :研究北京地区呼吸道感染患儿鼻咽部卡他莫拉菌的携带情况及其耐药性。方法 :对北京儿童医院 4 2 2例上呼吸道感染患儿的鼻咽拭子进行卡他莫拉菌培养、分离 ,对其携带情况及相关因素进行分析 ,BSAC纸片扩散法进行药敏试验 ,Nitrocefin纸片检测 β内酰胺酶。结果 :4 2 2例呼吸道感染患儿分离到 79株卡他莫拉菌 ,携带率为 1 8.7% ,其中 5月、8月和 9月的携带率分别为 33.0 %、8.4 %和 1 8.3%。 5月携带率明显高于 8、9月份 (P <0 .0 1 )。幼托患儿携带率 2 9.6 % ,明显高于居家患儿 1 7.4 % (P <0 .0 1 )。近期使用过抗菌药物组和未使用过抗菌药物组的携带率分别为 1 6 .0 %和 2 6 .8% ,两组差异有显著性 (P <0 .0 5 )。患儿卡他莫拉菌携带率与年龄无明显相关 (P >0 .0 5 )。 93.7%的分离株产 β内酰胺酶 ,对氨苄西林的耐药率分别为 89.2 % ,对头孢呋辛、头孢噻肟的耐药率为 2 8.4 %和 6 .8% ,对四环素和复方磺胺甲唑的耐药率分别为 33.8%和1 6 .2 % ,对红霉素和克拉霉素的耐药率分别为 6 .8%和 1 .4 %。未发现对头孢克洛、氯霉素和环丙沙星的耐药株。结论 :呼吸道感染患儿卡他莫拉菌的携带率与季节、是否上幼儿园及近期抗菌药物使用有关。北京地区儿童携带的卡他莫拉菌 β内酰胺酶阳性率很高 ,对?

Objective: To investigate nasopharyngeal carriage and antibiotic resistance of Moraxella catarrhalis (M. Catarrhalis) in children with respiratory tract infection in Beijing. Methods:Nasopharyngeal swabs of 422 children with respiratory tract infection from the outpatient department of Beijing Children's Hospital were cultured and identified for M. catarrhalis, H. influenzae and S.pneumoniae. The risk factors such as season, age, recent antibiotic usage and attending kindergarten on M.catarrhalis colonization were evaluated. BSAC (British Society for Antimicrobial Chemotherapy) disk diffusion test was used to determine the antibiotic resistance of M.catarrhalis and beta lactamases of these stratins were detected by nitrocefin disk. Results:18.3% of 422 children with respiratory tract infection carried M. catarrhalis. The carriage rates in May, August and September were 33.0%, 8.4% and 18.3%, respectively. The carriage rate in May was higher than the other months( P <0.001). Children in kindergarten M. catarrhalis were more common carrying than children not in kindergarten, with carriage rate of 29.6% and 17.4%, respectively ( P <0.05). The carriage rate of children who had been given antibiotics recently was 16.0%, and the rate in group which had not been given antibiotics was 26.8%. The difference was statistically significant ( P <0.05). The beta lactamase positive rate of M. catarrhalis was 93.7%. 89.2% of the isolates were resistant to ampicillin. The resistant rates to cefuroxime and cefotaxime were 28.4% and 6.8%, respectively. 33.8% and 16.2% of the isolates were resistant to tetracycline and co trimoxazole. Isolates resistant to chloramphenicol, ciprofloxacin and cefaclor were not found. Conclusions:The colonization of M. catarrhalis in children with respiratory tract infection is closely related with season, attending kindergarten and recent antibiotic usage. The beta lactamase positive rate of M. catarrhalis in Beijing is quite high. Resistance rates to the second generation cephalosporins and tetracycline are high, some isolates resistant to the third generation cephalosporins are emerging. Monitoring the antibiotic resistance of M. catarrhalis should be emphasized.