住院肺炎患儿不同血清型肺炎链球菌对抗菌药物的耐药性分析

目的 了解当前从我国住院肺炎儿童分离的肺炎链球菌血清型分布和不同血清型菌株对抗菌药物的耐药状况,评估应用疫苗预防儿童肺炎链球菌感染和控制耐药菌传播的价值。方法 肺炎链球菌分离自4家儿童医院呼吸科年龄 ≤ 5岁的住院肺炎患儿,采用荚膜肿胀试验进行血清型分析,E试验法检测菌株对8种抗菌药物的敏感性。结果 279株肺炎链球菌中以19F型为最常见（占60.6%）,其次为19A（9.7%）。23F（9.3%）和6B（5.4%）,7价结合疫苗（PCV7）覆盖率为81.0%,PCV7在青霉素不敏感菌株和敏感菌株中的覆盖率分别为84.2%（202/240）和61.5%（24/39）。超过90%的19F和19A型菌株对青霉素不敏感,19F型以中介株为主（71.6%）,19A型以耐药株为主（55.6%）。结论 住院儿童肺炎病例分离的肺炎链球菌以19F。19A。23F和6B型常见;PCV7覆盖大多数肺炎链球菌和青霉素不敏感菌株,应用该疫苗可有效地预防国内儿童肺炎链球菌感染和阻止耐药菌株传播;非PCV7覆盖的19A型具有较强耐药性。     

中国西部单中心二级医院呼吸道感染住院患儿鼻咽部肺炎链球菌携带及其血清型和耐药性的横断面调查

目的 了解不发达地区二级医院呼吸道感染住院患儿鼻咽部肺炎链球菌的携带情况及分离株的血清型分布和耐药性特征。方法 采集重庆市酉阳土家族苗族自治县人民医院（简称酉阳医院）2015年1~12月呼吸道感染住院患儿鼻咽拭子标本,培养并分离肺炎链球菌,采用荚膜肿胀实验对分离株进行血清分型。随机选取50%的肺炎链球菌分离株以E-test法和纸片扩散法对16种常见抗菌药物检测其敏感性。结果 研究期间共采集鼻咽拭子标本1 054份,分离出肺炎链球菌267株,分离率为25.3%。≤5岁儿童分离率较高,冬春季分离率较高。267株肺炎链球菌分离株中最常见的血清型为19F型（47株,17.6%）,其次为6A（35株,13.1%）、14（31株,11.6%）、19A（28株,10.5%）、23F（28株,10.5%）和6B型（25株,9.4%）。13价肺炎链球菌结合疫苗（PCV13）的覆盖率为73.8%（197/267）。136株肺炎链球菌行抗生素药敏试验,所有菌株对头孢曲松、万古霉素和左氧氟沙星敏感,对利奈唑胺、亚胺培南和泰利霉素的敏感率较高,分别为96.3%、87.5%和84.5%;静脉青霉素的敏感率为100%,口服青霉素的敏感率为16.9%。99.3%（135/136)的分离株对红霉素和阿奇霉素耐药。PCV13覆盖株对口服青霉素、头孢吡肟、头孢呋辛和亚胺培南的不敏感率明显高于非PCV13覆盖株（P<0.01）。19A型菌株对口服青霉素、头孢吡肟不敏感率为100%。结论 酉阳医院呼吸道感染住院患儿鼻咽部肺炎链球菌的分离率为25.3%,常见血清型为19F、6A、14、19A、23F和6B,PCV 13覆盖率较高,且PCV13覆盖株对口服青霉素、头孢吡肟、头孢呋辛和亚胺培南的不敏感率明显高于非PCV13覆盖株。     

四家儿童医院住院肺炎病例肺炎链球菌分离株的耐药性监测

目的：了解从我国住院肺炎儿童分离的肺炎链球菌对抗菌药物的敏感性状况,为临床用药提供依据。方法：肺炎链球菌分离自2006年2月~2007年2月在北京、上海、广州和深圳4家儿童医院住院的肺炎患儿,采用E试验法检测菌株对8种抗生素的敏感性。结果：279株肺炎链球菌对青霉素的不敏感率为86.0％,耐药率达23.3％。在检测的β内酰胺类抗菌药物中,肺炎链球菌对阿莫西林还保持着很高的敏感率（92.1％）,对头孢呋辛和头孢曲松的敏感率分别为19.0％和75.3％。几乎全部菌株（99.6％）对红霉素耐药。万古霉素和氧氟沙星的敏感率分别为99.6％和97.8％。17.6％的分离株对亚胺培南不敏感,以中介株为主。不同地区分离的肺炎链球菌对红霉素、万古霉素和氧氟沙星的敏感状况没有明显不同,但对其他几种抗菌药物的敏感性状况存在差异。结论：从肺炎住院儿童分离的肺炎链球菌对阿莫西林、万古霉素和氧氟沙星敏感率高,对头孢曲松和亚胺培南比较敏感,对青霉素、头孢呋辛和红霉素普遍不敏感或耐药。     

肺炎链球菌100株耐药性分析

目的　了解杭州地区小儿肺炎链球菌致病株的耐药特征。方法　用Kirby -Bauer法对浙江大学儿童医院 2 0 0 1年 7月至 2 0 0 2年 1月鉴定的 10 0株肺炎链球菌进行耐药性分析 ,同时用E -test法测定青霉素、氨苄西林、头孢噻肟和红霉素的最低抑菌浓度。结果　青霉素不敏感株 6 1株占 6 1% ,其中中介株占 46 % ,耐药株占15 % ,其最低抑菌浓度范围为 0 0 16～ 3 0 0 0mg/L ,平均 0 5 2 3mg/L。 92 %的菌株对红霉素耐药 ,对四环素、复方新诺明的耐药率也分别高达 85 %和 5 6 % ,氯霉素的耐药率为 16 %。多重耐药率为 6 3 % ,其中多数对红霉素、四环素和复方新诺明联合耐药。 99%的菌株对利福平敏感。未发现氨苄西林耐药株 ,但中介株达 43 %。所有的菌株都对头孢噻肟、万古霉素和氧氟沙星敏感。结论　杭州地区肺炎链球菌耐药现象比较严重 ,第三代头孢菌素是临床治疗耐青霉素肺炎链球菌感染的理想药物。     

大环内酯类抗生素对肺炎链球菌儿童株体外抗菌活性

目的了解大环内酯类抗生素对杭州地区肺炎链球菌儿童株的体外抗菌活性。方法对2001年7月至2002年2月浙江大学儿童医院鉴定的100株肺炎链球菌临床株和2002年2月至6月自入托幼儿分离到的53株健康携带株 ,用Kirby_Bauer琼脂扩散法检测其对红霉素、阿奇霉素和克拉霉素3种常用抗生素的耐药性 ,用E_test法检测红霉素的最低抑菌浓度 (MIC)。结果92.8 %的菌株 (142株 )对红霉素耐药 ,敏感株仅7.2 % (11株 ) ;红霉素MIC范围为0.047μg/ml～>256μg/ml,其中MIC>256μg/ml的高水平耐药株达73.9 %(113株)。肺炎链球菌对阿奇霉素和克拉霉素的耐药率均为92.8 % ,与耐红霉素情况完全一致。结论①红霉素能很好地代表大环内酯类抗生素对肺炎链球菌的体外活性 ;②大环内酯类抗生素对肺炎链球菌的体外抗菌活性差 ,不宜作为治疗肺炎链球菌感染的常规用药。     

住院患儿细菌培养标本分离肺炎链球菌特征分析

目的 分析住院患儿细菌培养标本中所检出肺炎链球菌的分布、血清型及耐药性特征。方法　收集2013年3月至2014年2月在首都医科大学附属北京儿童医院呼吸、感染及重症监护病房住院的195例患儿送检的细菌培养标本,对其进行肺炎链球菌常规检测、血清分型和药物敏感性试验。按照2013年临床实验室标准化委员会（CLSI）推荐的抗菌药物敏感性试验标准进行结果判断。应用WHONET 5.6软件对药敏结果进行耐药性分析。结果　195例患儿分离到肺炎链球菌,其中婴幼儿占66.1%。195例中共检出20种血清型,其中19F最多,占32.3%,其次19A,占20.5%。肺炎链球菌对红霉素和克林霉素最不敏感（敏感率＜5%）,对青霉素不敏感率为46.7%。与对青霉素敏感的肺炎链球菌进行抗菌药物耐药性比较后显示,青霉素不敏感肺炎链球菌对头孢噻肟、头孢吡肟、美罗培南和复方新诺明不敏感率均高于敏感菌株,差异存在统计学意义（P＜0.05）。结论　在儿科,肺炎链球菌的检出、流行型别的确定以及耐药性检测均不容忽视,应进行疫苗预防接种和合理选择抗菌药物进行抗感染治疗。     

2006年抚顺地区儿童肺炎链球菌耐药性分析

目的了解2006年抚顺地区儿童肺炎链球菌耐药性,以指导临床合理用药。方法对2006年在抚顺矿务局总医院鉴定的113例肺炎链球菌,用纸片扩散法进行常用抗生素敏感性检测。结果113株肺炎链球菌对青霉素、氨苄青霉素、阿莫西林/克拉维酸、头孢克洛、头孢噻肟、头孢哌酮、头孢曲松钠、环丙沙星、氧氟沙星、红霉素的耐药株数(耐药率)分别为93株(82.3%)、73株(64.6%)、72株(63.7%)、30株(26.5%)、18株(15.9%)、15株(13.3%)、3株(2.7%)、1株(0.9%)、1株(0.9%)、78株(69.0%)。结论抚顺地区儿童肺炎链球菌对青霉素、红霉素的耐药性比较严重,而对第三代头孢菌素类抗生素比较敏感,故第三代头孢菌素类抗生素是本地目前临床治疗耐青霉素肺炎链球菌感染的较佳药物。     

北京上海广州深圳4家儿童医院肺炎住院患儿肺炎链球菌分离株的血清型分布

目的了解目前从中国住院治疗肺炎患儿分离到的肺炎链球菌的血清型分布，及几种蛋白多糖结合疫苗的覆盖率，评估应用蛋白多糖结合疫苗预防肺炎链球菌感染的价值。方法选择2006年2月16日至2007年2月16日在首都医科大学附属北京儿童医院、复旦大学附属儿科医院、广州市儿童医院和深圳市儿童医院呼吸科住院治疗的肺炎患儿为研究对象，采用一次性吸痰管收集全部病例的呼吸道分泌物标本分离肺炎链球菌，部分患儿进行脑脊液、血液和胸腔积液中肺炎链球菌的分离。采用荚膜肿胀实验进行血清型分析。对4家儿童医院肺炎链球菌分离率和血清型进行分析，率的比较采用χ2检验或Fisher精确概率法。结果 研究期间共纳入2 865例肺炎患儿，2 865例呼吸道吸取物标本中分离到肺炎链球菌279株，其中有2株不同血清型菌株分离自同一病例，分离阳性率为9.7％（278/2 865）。3/8例胸腔积液中分离到肺炎链球菌，其中2例同时从呼吸道分泌物分离到肺炎链球菌，取其一进行血清分型，另1株从胸腔积液中分离的肺炎链球菌复苏失败，未进行血清分型。脑脊液和血液标本中未分离到肺炎链球菌。共有279株肺炎链球菌进行了血清型分析，以19F型最常见（60.6％，169/279），其次为19A（9.7％，27/279）、23F（9.3％，26/279）和6B（5.4％，15/279），上述4种血清型占全部菌株的84.9％（237/279）。肺炎链球菌7价结合疫苗（PCV7）覆盖率为81.0％，但在北京仅为46.0％，明显低于上海（80.0%）、广州(98.4%)和深圳（94.4%）。9价、10价和11价疫苗的覆盖率与PCV7相比并没有明显增加。13价疫苗的覆盖率（92.8％）较PCV7明显升高。结论4家儿童医院肺炎住院患儿分离的肺炎链球菌以19F、19A、23F和6B型常见。PCV7覆盖率为87％     

全国多地区儿童社区获得性肺炎住院患儿抗菌药物使用情况分析

目的 统计全国多地区儿童社区获得性肺炎（CAP）抗菌药物的使用情况，为进一步加强儿童CAP的规范治疗及抗菌药物合理使用提供参考依据。方法 统计2014年4月14日至2016年1月1日全国9个城市10家三甲医院儿科住院的1 383例CAP患儿的抗菌药物使用情况，分析华北、东北、华东、华南4个区域住院患儿的抗菌药物使用情况。结果 CAP患儿抗菌药物总使用率为89.08%，其中华北88.7%，东北95.5%，华东83.3%，华南86.6%。使用种类主要为头孢类、大环内酯类、β内酰胺类抗菌药物的复方制剂、多磷类广谱抗菌药物、其他β内酰胺类抗菌药物。抗菌药物的选用基本合理，但仍存在单纯病毒感染时使用抗菌药物、单纯感染时联用抗菌药物等现象；抗菌药物的不合理应用例数共有131例，不合理使用率为10.63%。结论 儿童CAP抗菌药物使用率、不合理用药率偏高，应加强对儿童CAP抗菌药物使用的规范化管理。     

2001年至2011年沈阳地区肺炎链球菌感染分布及耐药性变迁

目的 了解肺炎链球菌对青霉素等10种抗生素耐药性的动态变迁、感染病例的科室分布及耐药现状,为临床治疗肺炎链球菌感染提供参考依据.方法 采用法国生物梅里埃API鉴定系统、VITEK 2-COMPACT鉴定系统以及Optochin试验、胆汁溶解试验进行细菌鉴定;用K-B纸片扩散法联合浓度梯度法对青霉素、头孢噻肟等10种抗生素进行体外药敏试验,对2001年至2011年各年药敏结果进行分析.结果 11年来肺炎链球菌对临床常用抗生素的耐药率逐年上升,特别是青霉素的耐药率和不敏感率明显上升,已从2001年的8.3％上升至2011年的72.7％(脑膜炎86.4％,非脑膜炎59.0％);3代头孢菌素头孢噻肟的耐药率已占54.0％(脑膜炎64.0％,非脑膜炎44.0％);大环内酯类抗菌药物的耐药率为100％;未检测到万古霉素和利奈唑胺耐药菌株.结论 青霉素不敏感的肺炎链球菌已占很高的比例,肺炎链球菌青霉素、头孢菌素、大环内酯类抗菌药物耐药情况严重.临床在治疗肺炎链球菌引起的重症感染病例中应首选万古霉素和利奈唑胺或根据分离菌体外药敏结果选择合适的抗菌药物.     

Serotype distribution and antimicrobial resistance patterns in Streptococcus pneumoniae isolates from hospitalized pediatric patients with respiratory infections in Shanghai,China

BACKGROUND: Surveillance for pneumococcal respiratory illness was conducted in children hospitalized at Affiliated Pediatric Hospital of Fudan University in Shanghai from August 2000 to August 2001. METHODS: Sputum cultures were obtained from pediatric patients admitted with pneumonia or respiratory distress by tracheal aspirate. Blood cultures were also performed on a subset of patients. All pneumococcal isolates were serotyped and tested for antibiotic susceptibility. In addition clinical information on the patients including prior antibiotic history was abstracted. Streptococcus pneumoniae tracheal isolations were attempted in a total of 1013 pediatric patients hospitalized during this period. Among these samples 112 specimens were S. pneumoniae-positive. These positive isolates underwent serotyping and antibiotic susceptibility testing. RESULTS: Five serotypes (19F, 23F, 6A, 14, 6B) of S. pneumonia accounted for 81% (91 of 112 cases). Other serotypes accounted only for 12% (13 of 112 cases), and 7% (8 of 112 cases) of isolates could not be typed by quelling test. Only one blood culture isolate was positive, probably reflecting the frequent use of antibiotic treatment before hospitalization. Fifty-one and 8.0% of isolates had intermediate and high level penicillin resistance, respectively. Fifty-eight percent were resistant to ampicillin, 6.6% to cefazolin, 25.0% to cefaclor, 6.6% to ceftriaxone, 85.7% to erythromycin, 66.7% to clindamycin and 28.2% to chloramphenicol. Among 66 isolates that were not susceptible to penicillin, serotype 19F was the most common, followed by 23F and 14. CONCLUSION: S. pneumoniae is a common cause of respiratory illness requiring hospitalization in young children in Shanghai, with antibiotic resistance increasingly common. Five serotypes account for most disease.     

Distribution of serotypes and antimicrobial resistance of Streptococcus pneumoniae in a children's hospital in Turkey

Streptococcus pneumoniae isolates resistant to penicillin and other antibiotics have been increasing in many parts of the world. The aim of this study was to evaluate the antimicrobial susceptibilities to penicillin and other commonly used agents in 98 isolates recovered between 1997 and 1998 from clinical specimens from children, and to determine the serotypes/serogroups related to resistance. Susceptibility to penicillin was determined by E-test and disk diffusion tests were used for the other antimicrobials. Serotyping was performed on all the isolates by the quelling reaction. The rates of intermediate- and high-level resistance to penicillin were 29.6% and 2%, respectively. Overall resistance to trimethoprim-sulfamethoxazole was high (46%), of which 21% coexisted with penicillin resistance. Resistance rates to erythromycin and chloramphenicol were 5% and 1%, respectively. Five isolates were multi-drug resistant. The most frequent serotypes associated with penicillin resistance were serotypes 19, 23, 6, 9 and 15.     

Antibiotic resistance in Streptococcus pneumoniae isolated from children

OBJECTIVE: To determine the level of antibiotic resistance in pneumoniae (S. pneumoniae) isolated from nasal swabs of healthy children. METHOD: Cross-sectional community survey. SETTING: Survey was undertaken in general practice settings in Canberra during March and April 1998. SUBJECTS: Four hundred and sixty-one children under 3 years of age enrolled in general practice trial of clinical practice guidelines for antibiotic use. OUTCOME MEASURES: Resistance to penicillin, erythromycin, co-trimoxazole, tetracycline, chloramphenicol and cefotaxime among the isolates of S. pneumoniae. RESULTS: A total of 461 nasal swabs were collected and S. pneumoniae was isolated from 171 (37.1%). Penicillin resistance was found in 12.3% of these isolates, with high level resistance in 0.6%. Resistance rates were higher for cotrimoxazole (44.4%) and erythromycin (18.1%) than for penicillin. Multidrug resistance was found in 19% of these isolates. There was a significant association between the attendance at a day care centre and carriage of pneumococcus (53% vs 32%, odds ratio (OR) 2.4, 95% confidence interval (CI) 1.5-3.7, P < 0.001). Children who attended day care centers and had received antibiotics during the 4 months prior to swab collection were three times more likely to carry an antibiotic-resistant isolate than children who had neither attended a day care centre nor received antibiotics (68% vs 40%, OR 3.1, 95% CI 1.2-8.4, P = 0.02). CONCLUSION: The level of antibiotic resistance in pneumococci from healthy children was of concern. Carriage of pneumococcus was significantly higher in children who attended a day care centre. Resistance was significantly correlated with antibiotic use in combination with day-care attendance. These findings warrant more judicious use of antibiotics in children.     

Nasopharyngeal colonization and antimicrobial resistance of Streptococcus pneumoniae isolated from children with acute rhinopharyngitis

OBJECTIVE: To determine the prevalence and risk factors for nasopharyngeal colonization by, and to evaluate antimicrobial susceptibility of Streptococcus pneumoniae strains in children with acute rhinopharyngitis. METHODS: We collected nasopharyngeal swab specimens from 400 children aged 3 months to 5 years and with clinical status of acute rhinopharyngitis from June 16, 1997 to May 20, 1998 at the outpatient clinics of two hospitals in the city of S?o Paulo. Nasopharyngeal specimens were collected pernasally using a calcium alginate swab and plated immediately after collection onto trypticose soy agar with 5% sheep blood and garamicin 5 mcg/ml. Penicillin susceptibility was determined by oxacillin 1 mcg disk screening test and the minimal inhibitory concentration by the E-test. RESULTS: Pneumococci were recovered from 139 children, indicating a colonization prevalence of 35%. The risk factors analyzed indicated that the colonization was more prevalent in children attending day-care centers, children with siblings younger than 5 years, and children with recent use of antimicrobial agents. The prevalence of penicillin non-susceptible strains was of 16 % (20 strains). All strains were intermediately resistant (0.1mcg/ ml 相似文献   

肺炎链球菌临床分离株耐药性与耐药机制研究

目的 探讨肺炎链球菌(SP)临床分离株的耐药性及对大环内酯类抗生素的耐药机制,为临床用药提供依据.方法 回顾性分析2002年7月至2005年7月年重庆医科大学附属儿童医院964株SP临床分离株的耐药性;采用聚合酶链式反应扩增30株耐药SP基因组DNA,琼脂糖电泳分析SP大环内酯类抗生素耐药基因表达.结果 共分离获得964株SP,对红霉素、阿奇霉素和青霉素(实为苯唑西林)耐药率分别为91.8%、90.0%和61.0%,多重耐药率十分严重,占93.2%,主要是对红霉素、阿奇霉素、复方新诺明、四环素和青霉素(实为苯唑西林)耐药;其中绝大多数SP临床分离株对氧氟沙星、利福平和万古霉素敏感.分析30株对红霉素和阿奇霉素均耐药的SP临床分离株的耐药机制,24株同时具有erm基因和mef基因,4株只有erm基因,1株只有mef基因,1株未检测到erm或mef基因.结论 该研究结果提示重庆地区小儿SP临床分离株对大环内酯类抗生素耐药率较国内其他地区高,耐药模式以红霉素、阿奇霉素、复方新诺明、四环素和青霉素(实为苯唑西林)为主.erm基因介导的靶修饰作用和mef基因介导的外流排出机制的共同作用是重庆地区SP临床分离株时大环内酯类抗生素主要的耐药机制.     

Increased antimicrobial resistance among nonvaccine serotypes of Streptococcus pneumoniae in the pediatric population after the introduction of 7-valent pneumococcal vaccine in the United States

BACKGROUND: The 7-valent pneumococcal conjugate vaccine (PCV7) was introduced in the United States in February 2000. The PROTEKT US study evaluated serotype distribution, PCV7 coverage and antimicrobial susceptibility among Streptococcus pneumoniae isolates collected from children aged 0 to 14 years in 2000 through 2001 (year 1; n = 2033), 2002 through 2003 (year 3; n = 1740) and 2003 through 2004 (year 4; n = 1591). METHODS: Serotyping was performed by Neufeld Quellung reaction. Antimicrobial susceptibilities were determined centrally according to Clinical Laboratory Standards Institute methodology and interpretive breakpoints. RESULTS: The proportion of isolates covered by PCV7 (vaccine serotypes) decreased from 65.5% (year 1) to 34.7% (year 3) and to 27.0% (year 4) (P < 0.0001) with similar changes seen at regional and state levels. The most common serotypes in year 4 were nonvaccine serotypes (NVS) 19A (19.0% of all isolates), 6A (7.8%), 3 (7.6%), 15 (6.3%) and 35B (5.8%) and vaccine serotype 19F (12.7%). NVS 19A increased relative to vaccine serotype 19F among isolates expressing the erm(B) + mef(A) macrolide-resistant genotype (P < 0.0001) between year 1 (7.8% [19A] versus 86.7% [19F]) and year 4 (45.5% [19A] versus 51.7% [19F]). Antimicrobial resistance rates (year 1 versus year 4) among NVS from nonblood (respiratory tract) sources increased for penicillin (resistant: 12.7-16.1% [P = 0.0857]; intermediate susceptibility: 20.1-31.5% [P < 0.0001]), erythromycin (21.2-31.6% [P < 0.0001]), amoxicillin-clavulanate (1.4-5.8% [P < 0.0001]) and multidrug resistance (resistance to > or =2 antimicrobial classes) (24.6-31.6% [P = 0.0034]). CONCLUSIONS: The proportion of S. pneumoniae isolates from U.S. pediatric patients covered by PCV7 decreased substantially in the 4 years after vaccine introduction. However, resistance to commonly used antimicrobials, including beta-lactams and macrolides, as well as multidrug-resistant strains increased significantly among respiratory tract isolates of NVS.