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目的了解2003—2004年广州地区儿童呼吸道感染常见病原肺炎链球菌和流感嗜血杆菌对常用抗生素的敏感性,以便有效指导临床合理用药和预防。方法对2003—2004年在广州市儿童医院就诊的1565例上呼吸道感染儿童鼻咽分泌物进行培养,分离肺炎链球菌和流感嗜血杆菌;采用纸片扩散法及E-test方法对分离株进行常用抗生素敏感性检测。结果从1565例呼吸道感染儿童鼻咽部分离肺炎链菌球共172株,流感嗜血杆菌484株。172株肺炎链球菌对常用抗生素耐药株数(耐药率)分别为:青霉素55(32.0%)、阿莫西林/克拉维酸19(11.1%)、头孢曲松56(32.6%)、头孢呋辛31(18.1%)、头孢克洛68(39.5%)、红霉素142(82.6%)、四环素135(78.5%)、氯霉素42(24.4%)、复方磺胺甲基异唑150(87.2%)、克林霉素119(69.2%)、氧氟沙星5(3.1%);肺炎链球菌的青霉素不敏感株对β-内酰胺类、红霉素、复方磺胺甲基异唑耐药率明显高于青霉素敏感株,且多重耐药率在90%以上。484株流感嗜血杆菌中,143株β-内酰胺酶阳性,产酶率为29.5%,484株流感嗜血杆菌的耐药株数(耐药率)分别为:氨苄西林194(40.1%),阿莫西林/克拉维酸16(3.4%)、头孢曲松20(4.1%)、头孢呋辛9(1.9%)、头孢克洛27(5.6%)、复方磺胺甲基异唑272(56.2%)、四环素252(52.1%)、氯霉素84(17.4%)、阿奇霉素10(2.1%)、氧氟沙星3(0.6%)。结论广州地区儿童呼吸道肺炎链球菌和流感嗜血杆菌耐药形势严峻,与该地区前3年资料比较,肺炎链球菌对青霉素敏感性有所增加,但对头孢曲松耐药性增加,青霉素不敏感株的多重耐药率较高,以红霉素、四环素、复方磺胺甲基异唑多重耐药为主要特点。流感嗜血杆菌的产酶率上升,导致菌株对氨苄西林耐药性明显增高,对头孢二、三代抗生素、阿莫西林/克拉维酸、阿奇霉素有较高的敏感性。
Objective To understand the susceptibility to common antibiotics of common pathogens of Streptococcus pneumoniae and Haemophilus influenzae in children with respiratory tract infection in Guangzhou from 2003 to 2004 in order to effectively guide clinical rational drug use and prevention. Methods Nasopharyngeal secretions from 1565 children with upper respiratory tract infection who were treated in Guangzhou Children’s Hospital from 2003 to 2004 were cultured and isolated from Streptococcus pneumoniae and Haemophilus influenzae. Isolates were screened by disk diffusion and E-test Commonly used antibiotic susceptibility testing. Results A total of 172 isolates of S. pneumoniae from nasopharynx of 1565 children with respiratory tract infection and 484 strains of Haemophilus influenzae were obtained. 172 strains of Streptococcus pneumoniae commonly used antibiotic resistance (resistance rate) were: penicillin 55 (32.0%), amoxicillin / clavulanic acid 19 (11.1%), ceftriaxone 56 (32.6%), cefuroxime Cefaclor 68 (39.5%), erythromycin 142 (82.6%), tetracycline 135 (78.5%), chloramphenicol 42 (24.4%), sulfamethoxazole 150 (87.2 %), Clindamycin 119 (69.2%) and ofloxacin 5 (3.1%); penicillin-insensitive strains of Streptococcus pneumoniae were resistant to β-lactams, erythromycin and sulfamethoxazole Rate was significantly higher than penicillin sensitive strains, and multi-drug resistance rate of 90%. Of the 484 strains of Haemophilus influenzae, 143 strains were positive for β-lactamase, the yield of enzyme was 29.5%. The number of resistant strains of 484 strains of Haemophilus influenzae was ampicillin 194 (40.1%), Cefuroxime 20 (4.1%), cefuroxime 9 (1.9%), cefaclor 27 (5.6%), sulfamethoxazole 272 (56.2% ), Tetracycline 252 (52.1%), chloramphenicol 84 (17.4%), azithromycin 10 (2.1%) and ofloxacin 3 (0.6%). Conclusions The prevalence of Streptococcus pneumoniae and Haemophilus influenzae in children with respiratory tract infection in Guangzhou is very serious. Compared with the data of the previous three years in this area, the sensitivity of Streptococcus pneumoniae to penicillin increased, but the resistance to ceftriaxone increased. Penicillin was not The multi-drug resistance rate of sensitive strains is high, with erythromycin, tetracycline, sulfamethoxazole and multi-drug resistance as the main feature. The increase of enzyme producing rate of Haemophilus influenzae resulted in the higher resistance of the strain to ampicillin and higher sensitivity to the second and third generation antibiotics of cephalosporin, amoxicillin / clavulanic acid and azithromycin.