2000至2006年复旦大学附属儿科医院呼吸道感染患儿4种常见细菌分离率及耐药趋势

摘要 目的 了解复旦大学附属儿科医院2000至2006年呼吸道感染患儿流感嗜血杆菌、肺炎链球菌、化脓性链球菌和卡他莫拉菌的分离率及耐药趋势。方法 对29 416例呼吸道感染患儿进行4种致病菌分离率及耐药趋势回顾，细菌分离培养采用常规方法，药敏试验采用KB琼脂扩散法。结果 化脓性链球菌年分离率为10.7%～25.4%，占咽拭子致病菌首位，呈逐年上升趋势（P=0.01）。流感嗜血杆菌、肺炎链球菌及卡他莫拉菌在下呼吸道感染患儿痰液中年分离率分别为1.7%～8.9%、1.1%～5.9%和0.7%～4.7%，3种致病菌分离率变化不明显（P＞0.05），其中流感嗜血杆菌年分离率明显高于卡他莫拉菌（P=0.026）。痰液标本中未分离到化脓性链球菌。流感嗜血杆菌对氨苄西林耐药率为15.0%～.30.0%，上升趋势不显著（P=0.4），对头孢克罗耐药率为2.5%～11.2%，增加趋势明显（P=0.005）。青霉素高度耐药肺炎链球菌为4.2%～27.3%，低度耐药株为35.0%～61.2%，两者增加趋势显著（P<0.05）。化脓性链球菌对青霉素仍高度敏感，红霉素耐药率高达85%以上。卡他莫菌β-内酰胺类阳性率在95%左右。结论 化脓性链球菌是上呼吸道细菌感染的首要致病菌，分离率呈上升趋势，绝大多数已对红霉素耐药。流感嗜血杆菌、肺炎链球菌和卡他莫拉菌在下呼吸道感染患儿痰液标本中分离率变化不明显，其中流感嗜血杆菌对头孢克罗及肺炎链球菌对青霉素的耐药率呈明显增加趋势。

Recovery rates and antimicrobial susceptibility of Haemophilus infiuenzae, Streptococcus pneumoniae, Streptococcus pyogenens and Moraxella catarrhalis collected from children with respiratory tract infection in Children''''s Hospital of Fudan University from

Objective To investigate the trend of rates of recovery and drug resistance of H.influenzae, S.pneumoniae, S.pyogenens and M.catarrhalis collected from children with respiratory tract infection in Children's Hospital of Fudan University from 2000 to 2006. Methods A total of 29 416 patients were submitted to the trial. According to the routine technique of culture and test, four pathogens were collected from the sections of nasopharynx and sputum samples.Susceptibility test was performed by KB method and E-test. Results S. pyogenes were isolated by the rates of 10.7% to 2.4% from the nasopharynx, and the recovery rates were kept increasing （P=0.01） from 2000 to 2006. The frequent isolates were 1.7%-8.9% for H.influenzae,1.1%-5.9% for S.pneumoniae and 0.7%-4.7% for M.catarrhalis from sputum samples, however,all of thier changes were no statistically significant(P＞0.05). The recovery rates of H.influenzae collected from sputum samples were higher than that of M. catarrhalis（P=0.026）. There were no S. pyogenes isolates collected from sputum samples. The resistant rates of H.influenzae isolates to Ampicillin were ranged from 15.0% to 30% and no significant trend was found（P=0.4）. However, the resistant rates of H.influenzae isolates to Cefaclor, ranging from 2.5% to 11.2%,showed a significant increase (P=0.005). About 4.%-27.3% of S.pneumoniae were resistant to penicillin(PRSP), and 35.0%-61.2% were intermediate. Both of them showed significant increase statistically （P<0.05）. All of S.pyogenes isolates were highly susceptible to penicillin. But over 85% of S.pyogenes isolates were resistant to Erythromycin. Our data also indicated that about 95% of M. catarrhalis were β-lactamase positive. Conclusions The most frequent isolate was S.pyogenes collected from nasopharynx, and its recovery rate was kept increasing. Most of S.pyogenes isolates were resistant to Erythomycin.The changes of recovery rates of H.influenzae, S.pneumoniae and M.catarrhalis from sputum samples were not statistically significant. The resistant rates of H.influenzae isolates to Cefaclor and S.pneumoniae isolates to Penicillin showed a significant increase statistically.