241例重庆地区急性呼吸道感染患儿肺炎链球菌耐药性分析

Analysis of antimicrobial resistance of Streptococcus pneumonia among 241 children with acute respiratory infections in Chongqing

摘要:

目的：了解重庆地区儿童急性呼吸道感染肺炎链球菌（Streptococcus pneumoniae，ＳＰ）的耐药情况。方法：采集重庆医科大学附属儿童医院2014年1～3月、9～11月急性呼吸道感染患儿呼吸道标本（痰、支气管肺泡灌洗液），分离培养，得到SP进行药敏检测。结果：共收集241株SP，红霉素耐药率最高，达97.10%，四环素91.70%、克林霉素89.63%，未检出万古霉素耐药株；利奈唑胺、氯霉素、泰利霉素、左旋氧氟沙星、莫西沙星敏感率较高，达90%以上；青霉素、美洛培南、头孢吡肟的不敏感率分别为47.3%、81.74%、67.22%；主要耐药模式为美洛培南+红霉素+克林霉素+复方新诺明+四环素（21.16%）；青霉素敏感菌株和青霉素不敏感菌株相比，红霉素、阿莫西林、头孢吡肟、头孢噻肟、美洛培南、复方新诺明、克林霉素不敏感率差异有统计学意义（P<0.05）。结论：重庆地区红霉素、四环素、克林霉素耐药率较高，不宜用于儿童SP感染的治疗；青霉素和头孢类抗生素不敏感率较高，应慎重用于经验治疗。临床应根据药敏试验结果合理用药，防止耐药菌株流行播散。

Abstract:

Objective：To investigate and understand the resistance of Streptococcus pneumoniae in children with acute respiratory in－fections in Chongqing. Methods：The respiratory tract specimens（sputum，bronchoalveolar lavage fluid） from January to March，September to November in 2014 in the Children’s Hospital of Chongqing Medical University were collected，and Streptococcus pneu－monia were isolated and cultured，finally the drug sensitivity test results were achieved. Results：A total of 241 strains of Streptococcus pneumonia were isolated，erythromycin had the highest resistance rate，reaching 97.1%，followed by tetracycline 91.7%，clindamycin 89.63%. No drug-resistant strains of vancomycin was detected. Linezolid，chloramphenicol，telithromycin，levofloxacin，moxifloxacin were more sensitive，being more than 90%；Penicillin，meropenem，cefepime were not sensitive，being respectively 47.3%，81.74%，67.22%. The main patterns of resistance were meropenem+erythromycin+clindamycin+cotrimoxazole+tetracycline（21.16%）. Compared with penicillin-susceptible Streptococcus pneumoniae and penicillin-nonsusceptible Streptococcus pneumoniae，the nonsusceptible rates of erythromycin，amoxicillin，cefepime，cefotaxime，meropenem，cotrimoxazole，clindamycin had statistically significant difference（P<0.05）. Conclusion：Erythromycin，tetracycline，clindamycin should not be used in children infected with Streptococcus pneumoniae because of their higher resistance rates in Chongqing；and penicillin and cephalosporins should be carefully used in empirical treat－ment due to their high non-sensitive rates. The clinical medication should pay more attention to the bacterial culture，and rational use of antibiotics should be based on susceptibility test results，so as to prevent the spread and prevalence of drug resistant strains.