52株肺炎链球菌耐药性分析

目的调查分析临床标本分离到肺炎链球菌对青霉素等17种抗生素的体外抗菌活性,为临床治疗肺炎链球菌感染提供参考.方法对我院从2003年1月至2005年7月临床标本分离到的52株肺炎链球菌,用美国DADE-BEHRING公司的MICro STREP Plus链球菌药敏测定板检测肺炎链球菌对17种不同抗菌药物的MIC值.结果52株肺炎链球菌对红霉素、四环素的耐药率最高达71.2%,5株对青霉素耐药(9.6%),18株对青霉素低度耐药(34.6%),29株对青霉素敏感(55.8%),对阿奇霉素、克林霉素的耐药率为63.5%,对万古霉素、阿莫西林/棒酸、加替沙星的耐药率为0.00%.青霉素不敏感菌株对红霉素、阿奇霉素、克林霉素、氯霉素、头孢克洛、头孢呋辛的耐药率显著高于敏感株.结论肺炎链球菌对大环内酯类和四环素耐药率高,对青霉素以低度耐药为主,喹喏酮类药物和阿莫西林/棒酸刘肺炎链球菌抗菌活性较高,可作为首选药物.     

52株肺炎链球菌耐药性分析

目的调查分析临床标本分离到肺炎链球菌对青霉素等17种抗生素的体外抗菌活性，为临床治疗肺炎链球菌感染提供参考。方法对我院从2003年1月至2005年7月临床标本分离到的52株肺炎链球菌．用美国DADE—BEHRING公司的MICro STREP Plus链球菌药敏测定板检测肺炎链球菌对17种不同抗菌药物的MIC值。结果52株肺炎链球菌对红霉素、心环素的耐药率最高达71．2％，5株对青霉素耐药（9．6％），18株对青霉素低度耐药（34．6％），29株对青霉素敏感（55．8％），对阿奇霉素、克林霉素的耐药率为63．5％。对万古霉素、阿莫西林，棒酸、加替沙星的耐药率为0．00％。青霉素不敏感菌株对红霉素、阿奇霉素、克林霉素、氯霉素、头孢克洛、头孢峡辛的耐药率显著高于敏感株。结论肺炎链球菌对大环内酯类和凹环素耐药率高。对青霉素以低度耐药为主，喹喏酮类药物和阿莫西林，棒酸对肺炎链球菌抗菌活性较高，可作为首选药物。     

广州地区ermB和mef E基因介导对红霉素耐药的肺炎链球菌及其耐药性分析

目的了解广州地区对红霉素耐药的肺炎链球菌中ermB及mefE基因分布，比较ermB基因与mefE基因对红霉素耐药的肺炎链球菌的耐药性。方法用克林霉素纸片法检测199株对红霉素耐药的肺炎链球菌，并用浓度梯度法检测其耐药性。结果199株对红霉素耐药的肺炎链球菌中，ermB、mefE基因介导的耐药率分别为70．9％(141／199)和29．1％(58／199)。141株ermB基因介导对红霉素耐药的肺炎链球菌，对青霉素(MIC500．19μg／ml、MIC901．5μg／ml)、阿莫西林／克拉维酸(MIC500．19μg／ml、MIC901．0μg／ml)、头孢曲松(MIC500．19μg／ml、MIC900．75μg／ml)、头孢呋辛(MIC500．38μg／ml、MIC902．0μg／ml)、头孢克洛(MIC502．0Vg／ml、MIC9032．0μg／ml)的不敏感率分别为58．2％、0．7％、21．3％、46．1％和51．1％。58株mefE基因介导对红霉素耐药的肺炎链球菌，对青霉素(MIC500．5μg／ml、MIC901．5Vg／ml)、阿莫西林／克拉维酸(MIC500．38μg／ml、MIC901．0μg／ml)、头孢曲松(MIC500．38μg／ml、MIC900．75μg／ml)、头孢呋辛(MIC501．0μg／ml、MIC903．0μg／ml)、头孢克洛(MIC506．0μg／ml、MIC9048．0μg／ml)的不敏感率分别为67．2％、0、19．0％、58．6％和62．1％。结论广州地区对红霉素耐药的肺炎链球菌，其耐药机制以ermB基因介导为主；ermB基因介导的红霉素耐药水平高于mefE基因介导的耐药性。     

广州地区上呼吸道感染儿童肺炎链球菌耐药状况

目的 :了解广州地区肺炎链球菌的耐药情况 ,给临床合理用药提供重要依据。方法 :用鼻咽拭子采取2 0 0 0年 1月至 2 0 0 2年 12月我院呼吸科门诊及住院急性上呼吸道感染患儿鼻咽分泌物 ,划线接种于肺炎链球菌选择性培养基进行分离培养 ;用Etest法检测 3 2 7株肺炎链球菌对阿莫西林 /克拉维酸、青霉素、头孢曲松、头孢呋辛、头孢克洛和红霉素的耐药性 ,用K B法检测肺炎链球菌对氯霉素、四环素、克林霉素、复方新诺明的耐药性。结果 :广州地区上呼吸道感染儿童鼻咽部肺炎链球菌中 12 6%为低水平PRSP株 ;3 2 7株肺炎链球菌对阿莫西林 /克拉维酸除 2株中介外其他都敏感 ,对青霉素、头孢曲松、头孢呋辛、头孢克洛、红霉素、四环素、氯霉素、复方新诺明、克林霉素耐药率分别为 5 1 4%、0 6%、2 2 0 %、2 8 1%、80 5 %、75 7%、2 0 3 %、75 7%、5 9 4%。多重耐药发生率为75 % ,PNSP和PSSP菌株中多重耐药率分别为 89 3 % (15 0 /168)和 5 6 1% (90 /15 9) ,差异有显著意义 (χ2 =45 64 ,P<0 0 0 5 )。结论 :广州地区上呼吸道感染儿童鼻咽部肺炎链球菌耐药情况比较严重 ,并出现严重的多重耐药性 ,临床治疗儿童肺炎链球菌感染应首选 β 内酰胺类抗生素及加酶抑制剂的复合药物。     

肺炎链球菌192株对新喹诺酮类体外耐药性测定

目的：调查192株肺炎链球菌对青霉素、红霉素和环丙沙星等的耐药现状，并与新喹诺酮类进行比较。方法：根据美国国家I临床实验室标准委员会(NCCLS)2002年标准使用微量肉汤稀释法检测192株肺炎链球菌对青霉素、红霉素、克林霉素和喹诺酮类抗菌药物的最低抑菌浓度(MIC)。结果：肺炎链球菌对青霉素的耐药率(中介率 耐药率)已达42．7％，对红霉素的耐药率为77．6％，克林霉素、白霉素和环丙沙星的耐药率分别为66．7％、65．6％和57．3％，新喹诺酮类抗菌药物对之有较好的抗菌活性，敏感率皆大于90％；并与是否对青霉素、红霉素耐药无关。结论：在我国，肺炎链球菌对青霉素、红霉素的耐药率较高，新喹诺酮类抗生素有较好的抗菌活性。     

南京地区肺炎链球菌的耐药变迁及喹诺酮耐药机制研究

目的了解南京地区肺炎链球菌临床分离株的耐药性变迁及对喹诺酮类的耐药机制。方法收集2010-2012年南京7所教学医院共147株肺炎链球菌,琼脂稀释法测定9种抗菌药物的MIC,与南京2006-2007年分离的肺炎链球菌耐药情况进行比较。并对氟喹诺酮耐药株的gyrA、gyrB、parE和parC基因喹喏酮耐药决定区域（QRDR）进行PCR扩增及测序。结果147株肺炎链球菌中,对红霉素的耐药率为89．1％;青霉素不敏感肺炎链球菌（MIC≥4mg／L）占3．4％;对头孢呋辛、头孢曲松、美罗培南、左氧氟沙星、莫西沙星的耐药率分别为26．5％、1．4％、3．4%、1．4％、0．7％;所有分离株对万古霉素、利奈唑胺敏感。与2006-2007年分离株相比,2010-2012年临床分离株对青霉素、头孢呋辛耐药率下降,对红霉素、头孢曲松耐药率变化不大,出现了少数左氧氟沙星及莫西沙星耐药株。对喹诺酮耐药株进行基因测序发现1菌株有gyrA突变（Asn167-Ile）和ParE突变（Ile460～Val）;另1菌株则有ParC突变（Ser81-Gly;Asn94-Asp）。结论南京地区肺炎链球菌对红霉素耐药率居高不下,对青霉素仍较敏感,出现了少数莫西沙星、左氧氟沙星耐药株。喹诺酮耐药株有gyrA、parE和parC的QRDR突变。     

头孢地尼等抗生素对社区获得性呼吸道感染常见病原菌的体外抗菌活性研究

目的：测定头孢地尼对临床常见社区获得性呼吸道感染病原菌的体外抗菌活性,并与头孢呋辛、头孢克洛、阿奇霉素和氨苄西林比较.方法：琼脂稀释法测定抗生素的最低抑菌浓度（MIC）.结果：200株细菌测定结果表明：头孢地尼对甲氧西林敏感的金黄色葡萄球菌（MSSA）的敏感率为100%,抗菌活性与头孢呋辛、头孢克洛相似,明显强于阿奇霉素;青霉素敏感的肺炎链球菌（PSSP）对3种头孢菌素100%敏感,头孢地尼的MIC90值为0.25mg/L,与头孢呋辛相似;头孢地尼对革兰阴性菌的抗菌活性较高,对ESBLs阴性的肺炎克雷伯菌、流感嗜血杆菌、卡他莫拉菌的MIC90值分别为0.25、1、0.25mg/L,敏感率范围达97.2%～100%.流感嗜血杆菌对氨苄西林产生耐药性,敏感率仅达86.1%,但其MIC50值最低为0.06mg/L.耐甲氧西林的金黄色葡萄球菌（MRSA）、青霉素耐药的肺炎链球菌（PRSP）及产ESBLs的肺炎克雷伯菌对4种抗生素均耐药;头孢地尼对青霉素中介的肺炎链球菌（PISP）的抗菌活性比受试第二代头孢菌素和阿奇霉素强.结论：头孢地尼对革兰阳性球菌及革兰阴性菌均有较理想的体外抗菌活性,可作为治疗社区获得性呼吸道感染的较好选择.     

流感嗜血杆菌、肺炎链球菌和卡他莫拉菌的耐药性分析

目的了解我院临床分离的流感嗜血杆菌、肺炎链球菌和卡他莫拉菌的耐药性。方法对2012年1月-2013年8月我院不同标本分离的流感嗜血杆菌、肺炎链球菌、卡他莫拉菌,依照CLSl2010版标准判断药敏结果,采用WHONET5．6软件进行数据处理和统计分析。结果2012年1月-2013年8月我院共分离流感嗜血杆菌60株（产β-内酰胺酶16株）,肺炎链球菌60株、卡他莫拉菌43株（产β-内酰胺酶36株）,除1株流感嗜血杆菌和4株肺炎链球菌自血液标本分离外,其他均来源于痰标本。流感嗜血杆菌对复方新诺明的耐药率最高60％,氨苄西林的耐药率为28．6％．对阿莫西林,克拉维酸、头孢噻肟、氧氟沙星敏感率均在90％以上。肺炎链球菌对红霉素、克林霉素、四环素耐药率分别为95．7％、95．5％、86．7％,对头孢噻肟、左氧氟沙星、青霉素的耐药率分别为O％、2．3％、8．5％。卡他莫拉菌对阿莫西林／克拉维酸、头孢呋辛、头孢克洛、头孢噻肟、氧氟沙星均呈现高度敏感（敏感率〉90％）。结论流感嗜血杆菌和卡他莫拉菌对头孢菌素类、阿莫西林／克拉维酸以及喹诺酮类抗菌药物保持高度敏感性;产β-内酰胺酶仍是上述2种细菌对氨苄西林耐药的重要耐药机制;检出氨苄西林耐药而β-酰胺酶阴性的流感嗜血杆菌的分离株,其耐药机制有待进一步研究;肺炎链球菌对红霉素、克林霉素、四环素呈高水平耐药,头孢噻肟、左氧氟沙星、青霉素、阿莫西林是治疗肺炎链球菌所致感染的首选抗菌药物。对这些苛养菌造成的感染及其耐药性席当引起重视．临床廊根据具体的药物敏感试聆结果来指导用药以减少耐药菌株的产牛．     

脑脊液标本细菌培养及耐药性分析对重症脑出血术后颅内感染患者抗菌药物合理使用的影响

目的研究脑脊液标本细菌培养及耐药性分析对重症脑出血术后颅内感染患者的抗菌药物合理使用。方法选取2019年2月-2020年2月我院重症脑出血术后颅内感染患者142例,均行脑脊液标本细菌培养及耐药性分析。统计重症脑出血术后颅内感染患者脑脊液病原菌分布,并分析其耐药性。结果 142例重症脑出血术后颅内感染患者脑脊液标本共培养出病原菌179株,其中革兰阴性菌104株,革兰阳性菌61株,真菌14株;铜绿假单胞菌对氨苄西林/舒巴坦、复方新诺明、头孢呋辛耐药性为90.24%、85.37%、75.61%;大肠埃希菌对头孢呋辛、头孢曲松、复方新诺明耐药性为100.00%、100.00%、77.78%;肺炎克雷伯菌对头孢呋辛、头孢曲松、复方新诺明耐药性为100.00%、100.00%、90.91%;阴沟肠杆菌对头孢呋辛、氨苄西林/舒巴坦、复方新诺明耐药性为100.00%、100.00%、80.00%;鲍曼不动杆菌对头孢呋辛、头孢曲松、氨曲南耐药性为100.00%;凝固酶阴性葡萄球菌对复方新诺明、红霉素、阿奇霉素耐药性为67.74%、64.52%、64.52%;金黄色葡萄球菌对复方新诺明、阿奇霉素、红霉素耐药性为92.86%、71.43%、64.29%;肺炎链球菌对阿莫西林/棒酸、阿奇霉素、青霉素耐药性均为62.50%;肠球菌对阿奇霉素、红霉素、克林霉素耐药性均为80.00%、80.00%、100.00%。结论重症脑出血术后颅内感染患者脑脊液中病原菌种类繁多,且对多种抗菌药物耐药性不同,临床应据此合理选择抗菌药物,改善治疗效果。     

肺炎链球菌和流感嗜血杆菌分布及耐药性分析

目的：了解临床分离流感嗜血杆菌和肺炎链球菌的分布及耐药情况,为临床合理使用抗菌药物、预防和控制感染提供依据。方法：收集医院2005-2012年各类临床标本分离流感嗜血杆菌92株、肺炎链球菌83株,均经全自动细菌鉴定仪鉴定,用K—B法检测流感嗜血杆菌对常用的15种抗生素及肺炎链球菌对常见的13种抗生素的敏感性,并用头孢硝噻吩纸片法检测流感嗜血杆菌产β-内酰胺酶情况。结果：流感嗜血杆菌和肺炎链球菌主要来源于呼吸道标本,不同季节流感嗜血杆菌的感染率不同,冬春两季为高发季节,肺炎链球菌感染患者的年龄呈双峰分布,以年龄〈5岁和〉50岁的感染者最多。流感嗜血杆菌对氨苄西林、复方新诺明和头孢呋辛的耐药率较高,产β-内酰胺酶检出率为64．17％。肺炎链球菌对红霉素、氯霉素、四环素、克林霉素耐药性非常严重,其中47株（56．63％）为青霉素不敏感肺炎链球菌（PNSP）。结论：流感嗜血杆菌和肺炎链球菌耐药情况较为严重,对流感嗜血杆菌和肺炎链球菌的耐药性进行严密监测具有重要意义。     

Susceptibilities of Streptococcus pneumoniae and Haemophilus influenzae to 10 Oral Antimicrobial Agents Based on Pharmacodynamic Parameters: 1997 U.S. Surveillance Study

The susceptibilities of Streptococcus pneumoniae (1,476 strains) and untypeable Haemophilus influenzae (1,676 strains) to various oral beta-lactam, macrolide-azalide, and fluoroquinolone antimicrobial agents were determined by broth microdilution. Organisms were isolated from specimens obtained from outpatients in six geographic regions of the United States. MIC data were interpreted according to pharmacodynamically derived breakpoints applicable to the oral agents tested. Among H. influenzae strains, 41.6% were beta-lactamase positive. Virtually all H. influenzae strains were susceptible to amoxicillin-clavulanate (98%), cefixime (100%), and ciprofloxacin (100%), while 78% were susceptible to cefuroxime, 57% were susceptible to amoxicillin, 14% were susceptible to cefprozil, 9% were susceptible to loracarbef, 2% were susceptible to cefaclor, and 0% were susceptible to azithromycin and clarithromycin. Among S. pneumoniae isolates, 49.6% were penicillin susceptible, 17.9% were intermediate, and 32.5% were penicillin resistant, with penicillin MICs for 50 and 90% of the isolates tested of 0.12 and 4 microg/ml, respectively. Overall, 94% of S. pneumoniae isolates were susceptible to amoxicillin and amoxicillin-clavulanate, 69% were susceptible to azithromycin and clarithromycin, 63% were susceptible to cefprozil and cefuroxime, 52% were susceptible to cefixime, 22% were susceptible to cefaclor, and 11% were susceptible to loracarbef. Although ciprofloxacin has marginal activity against S. pneumoniae, no high-level fluoroquinolone-resistant strains were found. Significant cross-resistance was found between penicillin and macrolides-azalides among S. pneumoniae isolates, with 5% of the penicillin-susceptible strains being macrolide-azalide resistant, compared with 37% of the intermediate isolates and 66% of the resistant isolates. Resistance was highest in S. pneumoniae isolates from patients younger than 10 years of age, middle ear and paranasal sinus specimens, and the southern half of the United States. With the continuing rise in resistance, judicious use of oral antimicrobial agents is necessary in all age groups.     

Antimicrobial resistance of Streptococcus pneumoniae recovered from outpatients in the United States during the winter months of 1994 to 1995: results of a 30-center national surveillance study.

A total of 1,527 clinically significant outpatient isolates of Streptococcus pneumoniae were prospectively collected in 30 different U.S. medical centers between November 1994 and April 1995. Overall, 23.6% of strains were not susceptible to penicillin, with 14.1% intermediate and 9.5% high-level resistant. The frequencies of recovery of intermediate and high-level resistant strains varied considerably between different medical centers and in different geographic areas. In general, intermediate and high-level penicillin resistance was most common with isolates of S. pneumoniae recovered from pediatric patients. The in vitro activities of 22 other antimicrobial agents were assessed against this collection of isolates. Ampicillin was consistently 1 twofold dilution less active than penicillin. Amoxicillin and amoxicillin-clavulanate were essentially equivalent to penicillin in activity. The rank order of activity for cephalosporins was cefotaxime = ceftriaxone > or = cefpodoxime > or = cefuroxime > cefprozil > or = cefixime > cefaclor = loracarbef > cefadroxil = cephalexin. The National Committee for Clinical Laboratory Standards [Performance Standards for Antimicrobial Susceptibility Testing, Sixth Information Supplement (M100-S6), 1995] has established MIC breakpoints for resistance (i.e., > or = 2 micrograms/ml) with three cephalosporins versus S. pneumoniae, namely, cefotaxime, ceftriaxone, and cefuroxime. The overall percentages of strains resistant to these three antimicrobial agents were 3, 5, and 12, respectively. The overall frequency of resistance was 10% with all three macrolides examined in this study, clarithromycin, erythromycin, and azithromycin. The overall percentages of chloramphenicol, tetracycline, and trimethoprim-sulfamethoxazole resistance were 4.3, 7.5, and 18, respectively. The resistance percentages among the cephalosporins, macrolides, chloramphenicol, tetracycline, and trimethoprim-sulfamethoxazole were consistently higher among penicillin-intermediate strains than among susceptible isolates and even higher still among organisms expressing high-level penicillin resistance. Multiply resistant strains represented 9.1% of the organisms examined in this study. Finally, rifampin resistance was uncommon (i.e., 0.5%), and vancomycin resistance was not detected. The quinopristin-dalfopristin combination was consistently active at concentrations of 0.25 to 4 micrograms/ml, but rates of resistance could not be determined in the absence of established interpretive criteria for MIC results.     

Antimicrobial resistance among respiratory isolates of Haemophilus influenzae, Moraxella catarrhalis, and Streptococcus pneumoniae in the United States.

A national surveillance study was conducted to determine trends in antimicrobial resistance patterns among three common causes of community-acquired respiratory tract infections. Fifteen participating U.S. medical centers submitted clinically significant isolates of Haemophilus influenzae, Moraxella (Branhamella) catarrhalis, and Streptococcus pneumoniae to two central laboratories for testing with a group of 12 antimicrobial agents. The majority of isolates were recovered from adult males greater than 50 years old. Overall, 84.1% of 378 M. catarrhalis and 16.5% of 564 H. influenzae (29.5% of type b strains; 15.0% of non-type b strains) produced beta-lactamase and were thus resistant to penicillin, ampicillin, and amoxicillin. Resistance in H. influenzae to other agents was 2.1% to tetracycline, 0.7% to trimethoprim-sulfamethoxazole, 1.1% to cefaclor, and 0.2% to cefuroxime and amoxicillin-clavulanate, while the M. catarrhalis isolates yielded very low MICs of these latter drugs. As demonstrated in prior studies, erythromycin showed little activity against H. influenzae. Of 487 S. pneumoniae isolates, 1 (0.2%) was penicillin resistant, while 3.8% were relatively resistant to penicillin, 4.5% were resistant to trimethoprim-sulfamethoxazole, 2.3% were resistant to tetracycline, 1.2% were resistant to chloramphenicol, and 0.2% were resistant to erythromycin. Overall, the lowest resistance rates for these common bacterial respiratory pathogens were noted with amoxicillin-clavulanate, cefuroxime, and cefaclor.     

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。     

惠州地区淋球菌对抗菌药物的耐药性分析

目的了解惠州地区淋球菌对于6种抗菌药物的耐药性以及产β-内酰胺酶的淋球菌(PPNG)和质粒介导的高度耐四环素的淋球菌(TRNG)的流行情况。方法用琼脂稀释法测定青霉素、四环素、阿奇霉素、环丙沙星、头孢曲松钠及壮观霉素的最低抑菌浓度;用纸片碘法检测β-内酰胺酶。结果 137株淋球菌检出PPNG 51株(37.2%)、TRNG 82株(59.9%)、环丙沙星耐药菌株137株(100.0%)、阿奇霉素耐药菌株41株(29.9%),未发现头孢曲松钠、壮观霉素的耐药菌株。结论推荐壮观霉素和头孢曲松钠作为惠州地区治疗淋病的首选药物,同时定期监测淋球菌的耐药性。     

Antimicrobial Susceptibilities of 1,684 Streptococcus pneumoniae and 2,039 Streptococcus pyogenes Isolates and Their Ecological Relationships: Results of a 1-Year (1998–1999) Multicenter Surveillance Study in Spain

A nationwide multicenter susceptibility surveillance study which included 1,684 Streptococcus pneumoniae and 2,039 S. pyogenes isolates was carried out over 1 year in order to assess the current resistance patterns for the two most important gram-positive microorganisms responsible for community-acquired infections in Spain. Susceptibility testing was done by a broth microdilution method according to National Committee for Clinical Laboratory Standards M100-S10 interpretative criteria. For S. pneumoniae, the prevalences of highly resistant strains were 5% for amoxicillin and amoxicillin-clavulanic acid; 7% for cefotaxime; 22% for penicillin; 31% for cefuroxime; 35% for erythromycin, clarithromycin, and azithromycin; and 42% for cefaclor. For S. pyogenes, the prevalence of erythromycin resistance was 20%. Efflux was encountered in 90% of S. pyogenes and 5% of S. pneumoniae isolates that exhibited erythromycin resistance. Erythromycin resistance was associated with clarithromycin and azithromycin in both species, regardless of phenotype. Despite the different nature of the mechanisms of resistance, a positive correlation (r = 0.612) between the two species in the prevalence of erythromycin resistance was found in site-by-site comparisons, suggesting some kind of link with antibiotic consumption. Regarding ciprofloxacin, the MIC was >or=4 microg/ml for 7% of S. pneumoniae and 3.5% of S. pyogenes isolates. Ciprofloxacin resistance (MIC, >or=4 microg/ml) was significantly (P < 0.05) associated with macrolide resistance in both S. pyogenes and S. pneumoniae and with penicillin nonsusceptibility in S. pneumoniae.     

2010年上海地区细菌耐药性监测

目的 了解上海地区16所医院2010年临床分离细菌的耐药情况.方法 采用纸片扩散法(KB法)对临床分离菌株作药敏试验.采用CLSI 2010年版标准判断结果.结果 41326株临床分离株中,革兰阳性菌占30.3％,革兰阴性菌占69.7％.耐甲氧西林金葡菌(MRSA)和耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)的检出率各自为57.9％和78.9％,未发现万古霉素、替考拉宁和利奈唑胺耐药株.656株肺炎链球菌中7株为脑脊液分离的肺炎链球菌,其余为非脑膜炎分离株.儿童分离株中PSSP占71.2％,PISP和PRSP分别占17.0％和11.8％.成人分离株中97.0％为PSSP,1株为PISP.发现15株万古霉素耐药屎肠球菌和6株万古霉素耐药粪肠球菌,其中分别有11株和5株为vanA型耐药,其余均为vanB型耐药.大肠埃希菌、克雷伯菌属(肺炎克雷伯菌+产酸克雷伯菌)和奇异变形杆菌中产ESBLs分别占56.8％、40.8％和19.7％.肠杆菌科细菌对碳青霉烯类抗生素仍高度敏感,对亚胺培南和美罗培南的总耐药率＜5％.不动杆菌属对亚胺培南和美罗培南耐药率仍继续增高,耐药率分别为49.6％和51.2％.肺炎克雷伯菌和鲍曼不动杆菌中泛耐药菌株较2009年显著增多.结论 细菌耐药性仍呈增长趋势,对临床构成严重威胁,采取积极有效防控措施为当务之急.     

Surveillance of Streptococcus pneumoniae serotypes in Riyadh and their susceptibility to penicillin and other commonly prescribed antibiotics.

A total of 358 recent distinct isolates of Streptococcus pneumoniae were recovered from clinical specimens of patients in various hospitals in Riyadh, Saudi Arabia. The commonest serotypes were Groups C, F, B and A. Using specific monosera for typing it was found that serotype 14 was the commonest followed by serotypes 3, 7, 1, 2, 19 and 8 respectively. The minimal inhibitory concentrations (MIC) of penicillin determined by an agar dilution method, showed that 81% were susceptible (MIC less than 0.1 mg/L), 18% were relatively resistant (MIC = 0.1-1 mg/L) and 1% showed increased resistance (MIC greater than or equal to 1.0 mg/L). The use of a 1 microgram oxacillin disc distinguished between susceptible and relatively penicillin resistant pneumococci more reliably than did the use of a penicillin disc (1 or 10 micrograms). Resistance of S. pneumoniae to tetracycline, co-trimoxazole, chloramphenicol, and erythromycin were 70%, 43%, 12% and 4% respectively. All isolates were susceptible to oral cephalosporins (cefadroxil, cephalexin, cefaclor, and cefuroxime axetil) with an MIC range of less than or equal to 0.03-2 mg/L. The selection of antimicrobial therapy and the efficiency of vaccines depend on the knowledge of the local isolates of S. pneumoniae. Clinical isolates should be routinely screened to detect susceptibility to penicillin. The relatively high incidence of resistance to multiple antibiotics indicates the need to perform antibiotic susceptibility testing in order to avoid possible therapeutic failure.