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目的分析不同青霉素和红霉素敏感性组合模式的肺炎链球菌对其他常用抗生素敏感性分布的特征,探讨监测青霉素和红霉素敏感性是否具有代表性意义。方法对2000—2002年每年2～5月北京、上海、广州三家儿童医院门诊就诊(年龄1个月至5岁)的急性上呼吸道感染儿童鼻咽部分离肺炎链球菌,采用纸片扩散法和E-test最小抑菌浓度(MIC)法检测其对8种常用抗生素的敏感性。结果将青霉素敏感性分为R(耐药)、I(中介)和S(敏感),红霉素敏感性分为NS(不敏感)和S(敏感),按青霉素敏感性/红霉素敏感性组合模式可分为6组(没有分离到R/S模式菌株)。R/NS组29·8%(17/57)对头孢曲松不敏感;对头孢呋辛和头孢克洛均不敏感;阿莫西林/克拉维酸不敏感株只出现于R/NS组。I/NS组仅0·03%(8/288)对头孢曲松不敏感;头孢呋辛和头孢克洛不敏感率分别为38·2%(110/288)和52·4%(151/288)。头孢克洛不敏感菌株还出现于I/S组。复方新诺明敏感性主要与红霉素是否敏感有关。氯霉素耐药株在各组分布的差异没有统计学意义。R/NS和I/NS几乎都是联合耐药株,S/S组无联合耐药株。结论不同青霉素和红霉素敏感性组合模式的肺炎链球菌对其他常用抗生素敏感性分布具有各自不同的特点,青霉素和红霉素是肺炎链球菌耐药性监测的代表性药物。
Objective To analyze the distribution of susceptibility to other commonly used antibiotics in Streptococcus pneumoniae with different combination modes of penicillin and erythromycin sensitivity and to explore whether the sensitivity of monitoring penicillin and erythromycin is representative. Methods From April to May in 2000-2002, children with acute upper respiratory tract infection in three outpatient clinics in Beijing, Shanghai and Guangzhou Children’s Hospital (from 1 month to 5 years old) were separated from S. pneumoniae by disk diffusion method and E-test minimum inhibitory concentration (MIC) method to detect its sensitivity to eight commonly used antibiotics. The results of penicillin sensitivity divided into R (resistance), I (intermediary) and S (sensitive), erythromycin sensitivity divided into NS (insensitive) and S (sensitive), according to penicillin / erythromycin sensitive Sexual combination patterns can be divided into 6 groups (no R / S pattern isolates were isolated). In the R / NS group, 29.8% (17/57) were not sensitive to ceftriaxone, neither cefuroxime nor cefaclor. The amoxicillin / clavulanic acid insensitive strains only appeared in the R / NS group. The sensitivity of cefuroxime to cefaclor was 38.2% (110/288) and 52.4% (151/288) for ceftriaxone in the I / NS group only 0.03% (8/288) 288). Cefaclor insensitive strains also appeared in the I / S group. Cotrimoxazole sensitivity is mainly related to the sensitivity of erythromycin. Chloramphenicol resistant strains in the distribution of the difference was not statistically significant. Almost all of R / NS and I / NS were combined with drug-resistant strains, and no drug-resistant strains were found in S / S group. Conclusions Streptococcus pneumoniae with different combinations of penicillin and erythromycin have different characteristics on the sensitivity of other commonly used antibiotics. Penicillin and erythromycin are the representative drugs for monitoring the drug resistance of Streptococcus pneumoniae.