2016年中国多中心社区成人患者呼吸道3种常见临床分离菌药物敏感性测定

目的调查2016年全国16所医院社区成人患者呼吸道3种常见临床分离菌的耐药性。方法收集2016年1-12月全国16所医院分离的591株社区成人患者呼吸道分离菌,其中肺炎链球菌298株,流感嗜血杆菌222株,卡他莫拉菌71株。采用琼脂稀释法和肉汤微量稀释法测定不同抗菌药物对这3种菌的最低抑菌浓度。结果按照肺炎链球菌口服青霉素的折点判定标准,62.8%(187株)的肺炎链球菌为青霉素不敏感菌株(PNSP)。肺炎链球菌对大环内酯类的耐药率超过85.9%(256株),对口服头孢菌素的耐药率为54.7%~64.1%(163株~191株),对左氧氟沙星和莫西沙星的敏感率分别为96.3%(287株)和97.3%(290株)。PNSP株对头孢曲松、阿莫西林-克拉维酸、头孢克洛、头孢呋辛的耐药率显著高于青霉素敏感菌株(PSSP)。流感嗜血杆菌对头孢克洛、甲氧苄啶-磺胺甲噁唑和氨苄西林的敏感率分别为33.8%、33.8%和42.8%,对其余受试抗菌药物的敏感率均超过60%;β内酰胺酶阳性检出率为35.6%(79/222),且β内酰胺酶阳性菌株对氨苄西林、克拉霉素、氯霉素和四环素的耐药率显著高于β内酰胺酶阴性株。卡他莫拉菌对除克林霉素、阿奇霉素和克拉霉素外的抗菌药物都表现出较高的敏感性。结论肺炎链球菌、流感嗜血杆菌和卡他莫拉菌对受试的大环内酯类和口服头孢菌素类耐药率高,但左氧氟沙星和莫西沙星对肺炎链球菌、流感嗜血杆菌和卡他莫拉菌仍具有很高的抗菌活性,细菌耐药率低。

A multi-center community-based survey on the antimicrobial susceptibility of three common bacterial species isolated from the respiratory tract of adult patients in China during 2016

Objective To investigate the resistance profiles of three common pathogenic bacterial species in the respiratory tract of community-based adult patients in 16 hospitals across China during 2016.Methods From January to December 2016,a total of 591 strains of respiratory pathogens were isolated from 16 hospitals,including Streptococcus pneumoniae (298 strains),Haemophilus influenzae (222 strains),and Moraxella catarrhalis (71 strains).The minimum inhibitory concentration (MIC) of antibacterial agents was determined by agar dilution method and broth microdilution method.Results According to oral penicillin breakpoints,62.8% (187 strains) of S.pneumoniae were penicillin non-susceptible strains (PNSP).More than 85.9% (256 strains) and 54.7% (163 strains) to 64.1% (191 strains) of S.pneumoniae were resistant to macrolides and oral cephalosporins,respectively,but over 96.3% (287 strains) and 97.3% (290 strains) were susceptible to levofloxacin and moxifloxacin.PNSP strains exhibited significant higher resistance to ceftriaxone,amoxicillin-clavulanic acid,cefaclor and cefuroxime compared with penicillin susceptible S.pneumoniae (PSSP).The susceptibility rates of H.influenzae to the antimicrobial agents were over 60% except cefaclor (33.8%),trimethoprim-sulfamethoxazole (33.8%) and ampicillin (42.8%).The prevalence of β-lactamase positive H.influenzae were 35.6% (79/222).The β-lactamase positive H.influenzae strains were significantly more resistant to ampicillin,clarithromycin,chloramphenicol and tetracycline than β-lactamase-negative strains.M.catarrhalis strains were highly susceptible to all the antimicrobial agents tested except clindamycin,azithromycin and clarithromycin.Conclusions The isolates of S.pneumoniae,H.influenzae and M.catarrhalis were highly resistant to macrolides and oral cephalosporins in this study.Levofloxacin and moxifloxacin exhibited good activities against S.pneumoniae,H.influenzae and M.catarrhalis due to low resistance rates.