嗜血杆菌的分离及耐药性分析

目的了解衡阳市中心医院2010年10月至2011年11月嗜血杆菌的分离率、产酶率,并对其耐药性进行分析,指导临床合理用药,控制嗜血杆菌的流行。方法用嗜血杆菌选择性培养基对来自不同科室的607份临床标本（痰、咽拭子、支气管分泌物）进行分离培养,用卫星现象鉴定流感嗜血杆菌（haemophilus influenzae,Hi）与副流感嗜血杆菌（H.parainfluenzae,Hp）、头孢硝基噻吩纸片进行β-内酰胺酶测定,采用琼脂纸片扩散（K-B）法检测Hi和Hp对10种抗菌药物的耐药性。结果共分离培养出嗜血杆菌136株,检出率为22.4%（136/607）,其中流感嗜血杆菌31株,检出率为5.1%（31/607）,副流感嗜血杆菌105株,检出率为17.3%（105/607）;各科室中以呼吸内科检出率最高,检出率为9.7%（59/607）,其次为儿科和心内科,分别为2.6%、2.8%。136株嗜血杆菌对青霉素普遍耐药,耐药率高达90.4%,对洛美沙星和氧氟沙星的耐药率较高,分别是68.4%、48.5%,对头孢噻肟、头孢他啶、头孢呋肟的耐药率分别是9.6%、11.8%、22.1%,对四环素类如：四环素、强力霉素的耐药率分别为38.2%、8.8%,对壮观霉素、头孢曲松全部敏感,共检出产β-内酰胺酶菌株32株,产酶率为23.5%（32/136）。结论该院呼吸道嗜血杆菌感染以副流感嗜血杆菌为主,以呼吸内科感染最为严重,其次为儿科和心内科,临床上治疗嗜血杆菌感染的有效药物是头孢曲松、壮观霉素。

Separation of Haemophilus and analysis of its drug resistance

Objective To explore Haemophilus separation rate and their enzyme production rate in hospital from October 2010 to November 2011,and to analyse their resistance to drugs,in order to guide rational drug use in clinical and control the epidemic of Haemophilus.Methods Haemophilus selective medium was used to isolate and culture the 607 clinical specimens（sputum,throat swab,bronchial secretions） from different sections,the satellites phenomenon was used to identify the Haemophilus influenzae（Hi） and H.parainfluenzae（Hp）,and Cephalosporins nitro thiophene paper was used to detect β-lactamases,disk diffusion method（K-B） was used to detect the Hi and Hp resistance to 10 kinds of Antibiotics.Results 136 Haemophilus were isolated and cultured in all,the detection rate was 22.4%（136/607）,in which,31 were Haemophilus influenzae,and the detection rate was 5.1%（31/607）;105 were H.parainfluenzae,and the detection rate was 17.3%（105/607）.To the various sections,the highest detection rate was respiratory Medicine,and the detection rate was 9.7%（59/607）,this was followed by cardiac and pediatric medicine,were 2.6%,2.8% respectively.136 Haemophilus generally were resistant to penicillin,the resistance rate was as high as 90.4%,and the resistance rates to lomefloxacin and ofloxacin a bit higher,namely 68.4%,48.5%.To color of cephalosporin cefepime,ceftazidime,cephalosporins ceftiofur oxime,resistance rates were 9.6%,11.8%,22.1%,As for the tetracyclines,tetracycline and doxycycline,the resistance rates were 38.2% and 8.8%.136 Haemophilus were all sensitive to the spectacular adriamycin,ceftriaxone.32 β-lactamase-producing strains were detected,the rate of enzyme production was 23.5%（32/136）.Conclusion In Hospital,the dominant Haemophilus of the respiratory tract infection is H.parainfluenzae,and the department of respiratory medicine is most serious,followed by paediatric cardiac medicine,the effective drugs in clinical treatment of Haemophilus infection are ceftriaxone and spectacular adriamycin.