2000～2002年患儿呼吸道致病菌的耐药性研究

Resistance in respiratory tract pathogens of children during 2000～2002

目的 研究 2 0 0 0～ 2 0 0 2年上海地区患儿呼吸道流感嗜血杆菌、肺炎链球菌及卡他莫拉菌感染情况 ,肺炎链球菌的血清分型 ,3种致病菌对抗菌药物的耐药情况。方法 细菌的生化鉴定采用API鉴定系统 ,肺炎链球菌血清分型采用荚膜肿胀试验 ,β内酰胺酶测定采用头孢硝噻酚试验 ,抗生素敏感试验采用浓度梯度扩散法及琼脂扩散法。结果 流感嗜血杆菌持续 3年位居呼吸道致病菌首位 ,对氨苄西林素耐药率接近 2 0 %。卡他莫拉菌及肺炎链球菌分离率呈增加趋势 ,其中 17 2 %流感嗜血杆菌及 95 1%卡他莫拉菌 β内酰胺酶阳性。 72 7% β内酰胺酶阳性卡他莫拉菌对氨苄西林耐药。检测到 11种肺炎链球菌血清型 ,19F及 2 3F为主要血清型 ,青霉素耐药菌株 (PRSP)占 4 2 %。结论 流感嗜血杆菌、卡他莫拉菌及肺炎链球菌已成为上海地区患儿呼吸道主要院外感染致病菌。流感嗜血杆菌、肺炎链球菌感染对青霉素类抗生素已产生不同程度的耐药 ,19F、2 3F是本地区肺炎链球菌主要血清型。

Objective To investigate the percentage of Haemophilus influenzae, Moraxella catarrhalis, and Streptococcus isolated from children with actual respiratory tract infection. The resistance to the three isloates,the serotyping of Streptococcus pneumoniae and the β-lactamase-prouding of Hemophilus influenzae, Moraxella catarrhalis,and Streptococcus pneumoniae. Methods Haemophilus influenzae,Moraxella catarrhalis,and Streptococcus pneumoniae were identified by chemistry reaction . The β-lactamase was detected by Nitrocefin disc. Antibiotic susceptibility test was performed by E test and Kirby-Bauer disk diffusion method. Serotyping of Streptococcus pneumoniae was carried out by capsule swelling test. Results The isolates of Haemophilus influenzae were more than other pathogens during 3 years, and about 20% of Haemophilus influenzae were resistant to Ampicillin. The isolates of Moraxella catarrhalis and Streptococcus pneumoniae were gradually raising. β-lactamase-prouding test indicated that 17.2% of Haemophilus influenzae and 95.1% of Moraxella catarrhalis were β-lactamase positive ,and 72.7% Moraxella catarrhalis of β-lactamase-prouding were resistant to Ampicillin. Eleven serotypes of Streptococcus pneumoniae were found, and 19F, 23F were the main serotypes .Antibiotic susceptibility test showed that only 4.2% of Streptococcus Pneumoniae were resistant to penicillin (PRSP). Conclusions The Hamophilus influenzae , Moraxella catarrhalis , and Streptococcus pneumoniae have been the important community acquired pathogens. The main serotypes of Streptococcus pneumoniae were 19F,23F during the 3 years .The Penicillin was still used for the treatment of the Haemophilus influenzae and Streptococcus pneumoniae infection isolated from respiration tract, but it was not so effective in the treatment of Moraxella catarrhal infection. Several antimicrobial agents can be used to treat Moraxella catarrhali infection, such as cephlosporins ,macrolides, β-lactam and β-lactamase inhibitor combinant, quinolones and SMZ/TMP.