摘要
目的 了解当前我国儿科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 连续两年对北京、上海、广州三家儿童医院和西安西京医院儿科 (仅 2 0 0 1年 )就诊的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 四地 2年从呼吸道感染儿童鼻咽部分离肺炎链球菌共 6 5 4株 ,流感嗜血杆菌 6 6 9株。肺炎链球菌对青霉素不敏感 (PRSP)率范围在 14 %～ 6 0 % ,2 0 0 1年各地区发生率依次为上海 5 5 0 %、广州 5 0 0 %、西安4 5 0 %、北京 4 2 3% ;与 2 0 0 0年相比 ,2 0 0 1年部分地区如北京、上海青霉素中度敏感株明显增多。PRSP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 (PSSP) ,且多重耐药率高达 90 %以上。北京、上海、西安地区分离株对阿莫西林 /克拉维酸、头孢曲松仍具有很好的敏感性 (96 6 %～ 98 9% ) ,而对头孢呋辛敏感性有不同程度下降 ,广州地区敏感率仅为 5 9% ,上海 71% ,而北京地区为 92 3% ,明显高于广州地区。 2 0 0 1年四地区分离株对头孢克洛总耐药率 :广州地区耐药率最高 (5 6 % ) ,上海、西安次之
Objective To investigate the situation of antibiotic resistance of S. pneumoniae (Sp) and H. Influenzae (Hi) for clinical isolates among Chinese children. Methods The authors cultured, isolated and identified the Sp and Hi strains from patients who visited children′s hospitals in Beijing, Shanghai and Guangzhou between 2000 and 2001, and department of pediatrics of Xijing Hospital in Xi′an in 2001 with respiratory infections. Tests of antibiotic susceptibility were done for these clinical isolates. Results The average rates of nasopharyngeal carriage for Sp and Hi in these hospitals were 23.9% and 24.5%, respectively. The penicillin resistant Sp (PRSP) isolates accounted for 14%-60%. In 2001, the rates of PRSP in Shanghai, Guangzhou, Xi′an and Beijing were 55%, 50%, 45% and 42.3% in 2001, respectively. An increased PRSP was found in Beijing and in Shanghai in 2001, compared with that in 2000. PRSP isolates showed a high resistance to other antimicrobial agents such as other β lactam antimicrobial agents, erythromycin, and trimethoprim/sulfamethoxazole as compared to penicillin susceptible Sp (PSSP) isolates. More than 90% of PRSP were multidrug resistant strains; 96.6%-98.9% of Sp isolated from Beijing, Shanghai, and Xi′an were susceptible to amoxicillin/clavulanic acid and ceftriaxone. Strains from Guangzhou and Shanghai had decreased susceptibilities (59% and 71%, respectively) to cefuroxime as compared to those from Beijing (92.3%) in 2001. The rates for cefaclor resistance were higher in Guangzhou (56%) than in Shanghai (15%), Xi′an(13%) and Beijing (4.8%). The prevalence of erythromycin resistant Sp in this study was up to 75%-96%. Of them, the predominant resistant strains (MICs ≥256 mg/L) were about 80%-90%. Erythromycin resistant Sp in Beijing accounted for 87 9%, respectively, whereas in Shanghai and Guangzhou it accounted for 80% and 70%, respectively. The resistant rate to erythromycin in Beijing area was significantly higher than that of Shanghai and Guangzhou. The prevalence of tetracycline resistant Sp in four hospitals was similar to that of erythromycin with a range of 60%-96% and trimethoprim sulphamethoxazole (TMP SMX) resistant rates were as high as 68%-88%. The chloramphenicol resistant isolates were in stable low levels (20%-30%). For Hi isolates, the resistant rates to ampicillin and chloramphenicol were 5%-16% in this study. 96%-100% of isolates tested were susceptible to amoxicillin/clavulanic acid, cefuroxime and ceftriaxone. But in 2001, cefaclor resistant Hi strains were up to 12.7% in Beijing and 20% in Guangzhou, respectively. The resistant rates were 11.3%-26 5% for tetracycline and 37 5%-77.1% for TMP SMX in the four hospitals. Conclusion The resistant Sp and Hi isolated from children with respiratory tract infection in four hospitals would be a severe problem. PRSP rate was increased and was characterized by a multi resistance to erythromycin, tetracycline and TMP SMX.
出处
《中华儿科杂志》
CAS
CSCD
北大核心
2002年第8期461-466,共6页
Chinese Journal of Pediatrics
基金
国家自然科学基金资助 (3 0 0 70 793 )
