成都地区肺炎链球菌对抗菌药物的耐药性调查

目的 了解成都地区临床分离的肺炎链球菌的耐药性，为肺炎链球菌感染临床合理应用抗菌药物提供理论依据。方法 二倍琼脂稀释法测定11种抗菌药物对肺炎链球菌的最低抑菌浓度(MIC)。结果 91．94％菌株对青霉素敏感，8．06％中度耐药；88．71％菌株对SMZ／TMP敏感，11．29％中度耐药；肺炎链球菌对头孢呋辛、头孢噻肟、头孢毗肟、氧氟沙星、司帕沙星、美洛培南、万古霉素敏感率为100％；对红霉素、克林霉素耐药率相当高，分别达到62．90％和74．19％。结论 成都地区肺炎链球菌对青霉素耐药率较低，而对大环内酯类和克林霉素类耐药率较高。     

2004～2009年临床分离肺炎链球菌的血清型/群分布及耐药性监测

目的：了解当前本院临床分离肺炎链球菌的血清型/群分布及耐药趋势,为临床合理使用抗生素提供参考。方法：以2004～2009年临床分离的822株肺炎链球菌为研究对象,采用荚膜肿胀试验进行血清分型/群,E-test检测菌种对青霉素、头孢呋辛、头孢地尼、头孢克罗、红霉素、四环素、左氧氟沙星、万古霉素等8种抗生素的敏感性。结果：2004年青霉素不敏感肺炎链球菌（PNSP）的分离率为49.4%,并呈逐年上升趋势,至2006年PNSP分离率高达67.8%,2009年下降至51.0%。822株肺炎链球菌最常见的型/群是19群,其次是23、6、14、3、其他。PNSP在6种血清型/群中所占的比例在2004～2009年期间无显著性变化（P〉0.05）。肺炎链球菌对其他β内酰胺类抗生素的非敏感趋势类似青霉素,对红霉素、四环素的非敏感率始终在60%以上,其中青霉素耐药肺炎链球菌（PRSP）对红霉素和四环素几乎100%耐药,对左氧氟沙星、万古霉素的非敏感率均〈3%。结论：临床分离肺炎链球菌以19群、23群、6群、14群、3群常见;对β内酰胺类抗生素的非敏感率自2007年呈下降趋势,且对左氧氟沙星、万古霉素始终具有较高的敏感性。     

2004—2009年益阳市中心医院临床分离肺炎链球菌的血清型/群分布及耐药性监测

目的了解近5年益阳市中心医院临床分离肺炎链球菌的血清型/群分布及耐药趋势,为临床合理使用抗生素提供参考。方法以2004—2009年期间临床分离的822株肺炎链球菌为研究对象,采用荚膜肿胀试验进行血清分型/群,E-test检测菌种对青霉素、头孢呋辛、头孢地尼、头孢克罗、红霉素、四环素、左氧氟沙星、万古霉素等8种抗生素的敏感性。结果 2004年青霉素不敏感肺炎链球菌(PNSP)的分离率为49.4%,并呈逐年上升趋势,至2006年PNSP分离率高达67.8%,2009年下降至51.5%。822株肺炎链球菌最常见的型/群是19群,其次是23、6、14、3群和其他。PNSP在6种血清型/群中所占的比例在2004—2009年期间无显著性变化(P>0.05)。肺炎链球菌对其他β内酰胺类抗生素的非敏感趋势类似青霉素,对红霉素、四环素的非敏感率始终在60%以上,其中青霉素耐药肺炎链球菌(PRSP)对红霉素和四环素几乎100%耐药,对左氧氟沙星、万古霉素的非敏感率均<3%。结论临床分离肺炎链球菌以19、23、6、14、3群常见;对β内酰胺类抗生素的非敏感率自2007年呈下降趋势,且对左氧氟沙星、万古霉素始终具有较高的敏感性。     

湘潭市中心医院社区获得性肺炎住院患儿肺炎链球菌的耐药性研究

目的了解湘潭市中心医院因社区获得性肺炎住院的患儿肺炎链球菌(SP)的耐药情况。方法对本院2010-2011年住院患儿分离的115株SP进行分析,采用K-B纸片琼脂扩散法及浓度梯度法(E测试)检测SP对青霉素、头孢曲松、红霉素、克林霉素、左氧氟沙星、万古霉素、利奈唑胺、复方磺胺甲噁唑的耐药性。结果 115株SP中青霉素敏感肺炎链球菌(PSSP)占86.1%,青霉素中介肺炎链球菌(PISP)占7.8%,青霉素耐药肺炎链球菌(PRSP)占6.1%。SP对红霉素、克林霉素及复方磺胺甲噁唑的耐药率分别为95.6%、94.8%和73.9%,左氧氟沙星的耐药率为1.7%,头孢曲松的耐药率为6.9%,未发现对万古霉素及利奈唑胺耐药的SP菌株。结论本院分离的SP对儿科常用抗生素青霉素及头孢曲松钠仍高度敏感,但对大环内酯类抗生素红霉素、林可酰胺类抗生素克林霉素耐药情况严重。     

204株肺炎链球菌的耐药性分析

目的了解襄樊市东风公司襄樊医院肺炎链球菌分布和耐药情况。方法应用K-B纸片扩散法检测对襄樊市东风公司襄樊医院2006年7月至2009年6月从临床分离的204株肺炎链球菌对青霉素等8种抗生素的敏感度,用E-test法检测对苯唑西林耐药的肺炎链球菌青霉素的MIC值。结果青霉素的耐药呈上升趋势,尤其是2008年7月至2009年6月。肺炎链球菌对克林霉素、红霉素、四环素的耐药性较高,分别为90.2%、83.3%、89.2%;对青霉素的耐药率为52.5%,对头孢噻肟的耐药率为15.7%;对氯霉素、氧氟沙星的耐药率较低,分别为23.5%、5.4%,未检出对万古霉素耐药的菌株。青霉素不敏感肺炎链球菌(PNSSP)的E-test检测结果以中介菌株为主,PNSSP的MIC值最高达到6μg/mL。结论襄樊市东风公司襄樊医院分离的肺炎链球菌耐药较为严重,耐青霉素的肺炎链球菌不断上升,有必要对其进行耐药性监测,指导临床合理选择抗菌药物。     

论文摘要

成都地区肺炎链球菌对抗菌药物的耐药性调查曾雪峰　吕晓菊　雷秉钧　俞汝佳　冯萍　高燕渝(四川大学华西医院 ,　成都 610 0 41)了解成都地区临床分离的肺炎链球菌的耐药性 ,为肺炎链球菌感染临床合理应用抗菌药物提供理论依据。采用二倍琼脂稀释法测定 11种抗菌药物对肺炎链球菌的最低抑菌浓度 (MIC)。结果 ,91 94%菌株对青霉素敏感 ,中度耐药为 8 0 6% ;88 71%菌株对SMZ/TMP敏感 ,中度耐药为 11 2 9% ;肺炎链球菌对头孢呋辛、头孢噻肟、头孢吡肟、氧氟沙星、司帕沙星、美洛培南、万古霉素敏感率为 10 0 % ;红霉素、克林霉素耐药率相…     

南昌地区肺炎链球菌耐药性分析

目的了解南昌地区肺炎链球菌耐药情况,指导临床合理使用抗生素。方法用琼脂稀释法对临床分离的100株肺炎链球菌进行青霉素等12种抗菌药物最低抑菌浓度（M IC）的测定。结果肺炎链球菌对青霉素的不敏感率为57.0%、,其中高度耐药率25.0%,中度耐药率32.0%;头孢呋辛耐药率为38.0%,头孢噻肟、头孢曲松、氯霉素、左氧氟沙星的耐药率分别为12.0%、17.0%、20.0%和7.0%。对红霉素、阿奇霉素、四环素、复方新诺明、克林霉素有较高耐药率,分别为86.0%、90.0%、89.0%、86.0%和90.0%,未检出对万古霉素耐药的菌珠。结论南昌地区肺炎链球菌耐药严重,且多为多重耐药株,临床应合理选择用药。     

小儿下呼吸道感染肺炎链球菌耐药性分析

目的了解我院住院患儿感染肺炎链球菌的耐药性状况。方法收集儿科2010年1月至2012年1月患儿连续3次痰培养肺炎链球菌进行耐药分析。采用纸片扩散法（K—B法）,药敏试验结果按NCCL200版判断标准,对照质控菌株判断敏感、中介、耐药。结果所有菌株对万古霉素敏感,耐药率为0,左氧氟沙星敏感率率较高,耐药率为3．3％,菌株对红霉素的耐药率最高,其次为克林霉素。红霉素、克林霉素耐药率为90．2％和89．3％,对复方新诺明、青霉素的敏感率有下降趋势。青霉素G耐药率为82．7％,阿莫西林克拉维酸钾、美洛西林舒巴坦的耐药率13．1％和16．4％,头孢呋辛和头孢噻肟的耐药率分别为18．9％和19．7％。结论儿科冬季下呼吸道感染。肺炎链球菌多见,以婴幼儿多见,早期用药效果欠佳,易出现并发症,并发脓胸、肺脓肿、肺炎、心肌炎,甚至并发感染性休克,应动态监测肺炎链球菌的耐药情况。指导临床合理选择抗生素,提高治愈,减少并发症。     

患儿非侵入性肺炎链球菌血清型及抗生素耐药性研究

目的研究患儿非侵入性肺炎链球菌血清型和抗生素耐药性。方法回顾性分析863例患儿的非侵入性肺炎链球菌分离株血清学分型和抗生素敏感性试验结果。另选取860例健康儿童作为对照组,对2组患儿相关生化指标进行对比分析。结果共得到45个不同的血清型。其中6个主要血清型(流行率大于5.0%)为19F(21.7%),6B(12.8%),23F(10.1%),14(9.0%),6A(8.4%)和3(7.5%)。大多数多重耐药菌分离株的血清型为6B,14,19A,19F。28%的分离株为青霉素不敏感型。红霉素的耐药率为26%。克林霉素的耐药率为32%(6/19)。肺炎患儿hs-CRP、PCT、WBC、PLT、ESR、ALT和CK-MB水平高于健康对照组,差异有统计学意义(P<0.05)。结论耐药肺炎链球菌血清型分布增多。双重大环内酯耐药肺炎球菌菌株的出现需要高度监控。     

265株肺炎链球菌临床分离株的临床特点、血清分型及耐药性分析

目的 了解临床标本分离的肺炎链球菌的临床特点、血清分型及对常用抗菌药物的耐药性,为临床合理用药提供依据.方法 参照《临床检验操作规程》第4版对分离菌株进行鉴定、体外药敏分析及血清分型,并运用WHO-NET5.6及SPSS 13.0软件对结果数据进行统计分析.结果 7岁以下、50岁以上患者占90.2％ (239/265),265株肺炎链球菌主要来源于呼吸道标本占89.1％ (236/265),血培养检出仅占7.9％ (21/265).血清型主要有23F(占31.7％),19F(占21.1％),6A(占9.8％),6B(占5.7％),19A(占4.9％),14(占4.2％),未能分型占22.6％.红霉素、克林霉素、青霉素、复方新诺明和四环素的耐药率最高,对左旋氧氟沙星、利福平和奎如普汀/达福普汀耐药率低,未检出万古霉素、利奈唑胺耐药的菌株.儿科病房患者分离株和非儿科患者分离株对10种抗菌药物(除青霉素外)的耐药率差异无统计学(P＞0.05).有10种抗菌谱,同时对5种抗菌药物不敏感(包括耐药和中介)有111株.结论 肺炎链球菌主要来源于50岁以上的老年人和7岁以下的学龄前儿童;其血清型分布广泛,但相对集中,以23F、19F、6A为主,本次分离的肺炎链球菌耐药较为严重,万古霉素、利奈唑胺和左旋氧氟沙星对该菌具有很强的抗菌活性.     

Nasopharyngeal carriage, antimicrobial susceptibility, serotype distribution and clonal relatedness of Streptococcus pneumoniae isolates in healthy children in Malatya, Turkey

The aims of this study were to assess the nasopharyngeal colonisation rate, serogroup and antibiotic susceptibility patterns of Streptococcus pneumoniae strains isolated from healthy children. Of 848 children, 162 (19.1%) were found to be carriers. The carrier rate was significantly higher in the 7-year-old age group. Children from the slums of the city had higher carriage rate (23.7%) than those in the centre of the city (17.7%), but this was not statistically significant. The number of intermediate penicillin-resistant strains was 17 (10.5%). No high-level penicillin-resistant S. pneumoniae strain was found. The rates of resistance to co-trimoxazole, erythromycin, tetracycline and clindamycin were 11.7%, 4.9%, 4.3% and 3.7%, respectively. All isolates were uniformly susceptible to rifampicin, moxifloxacin, levofloxacin and vancomycin. Fourteen different serogroups were identified. The most prevalent serogroups in descending order were 9, 19, 23, 10, 6 and 18, accounting for 76.3% of the isolates. Arbitrarily primed polymerase chain reaction typing of 105 isolates revealed that 25 (23.8%) of the isolates were clonally indistinguishable. This value was 20.9% in children from the central area and 36.8% in those from the slum of the city. There was no relationship between serogroups and genotypes, i.e. strains within the same serogroup yielded the same or different genotypes, and vice versa. In conclusion, serogrouping results give a preliminary idea about the possible coverage of a future pneumococcal vaccine. Penicillin G is still a suitable agent for the empirical treatment of pneumococcal infections in our population. Living in the slum of the city may lead to both increased carriage and clustering rates of S. pneumoniae among healthy children.     

Antibiotic susceptibility and serotype distribution in Streptococcus pneumoniae circulating in Italy: results of the SEMPRE surveillance study (2000-2002)

During 2000-2002, 20 clinical microbiology centres collected 1623 Streptococcus pneumoniae isolates. Susceptibility to penicillin, amoxicillin, amoxicillin/clavulanic acid, cefaclor, cefuroxime, cefotaxime, clarithromycin, ciprofloxacin, levofloxacin, rifampicin and teicoplanin was determined locally by the Etest and/or by the microdilution method by three co-ordinating centres. Total resistance to penicillin increased from 15.2% to 16.1% and macrolide resistance increased from 37.9% to 43.7%. Overall, the most effective drugs (>99% susceptible strains) were amoxicillin, amoxicillin/clavulanic acid, levofloxacin and rifampicin. The most frequent serotypes were: 23F (15.8%), 3 (10.8%) 14 (9.1%), 19F (9.1%), 6B (7.2%), 19A (6.9%) and 6A (4.8%). In conclusion, penicillin and macrolide resistance is increasing in Italy, whilst fluoroquinolone currently remains active. The most common serotypes circulating are included in the heptavalent conjugate vaccine, with the exception of type 3.     

耐甲氧西林金葡菌的头孢西丁检测法与耐药性分析

目的评价头孢西丁纸片扩散法检测耐甲氧西林金葡菌（MRSA）的效果．了解MRSA的耐药状况。方法用头孢西丁及苯唑西林纸片扩散法、mecA基因聚合酶链反应（PCR）检测MRSA．并以mecA基因PCR法为参考方法与头孢西丁及苯唑西林纸片扩散法检测MRSA进行比较分析。按CLSI（原NCCLS）规定的标准测定MRSA对青霉素等10种抗生素的耐药率（KB法）。结果95株金葡菌（SA）中mecA基因阳性株42株。头孢西丁纸片法筛选出40株MRSA，其中39株mecA基因阳性，方法特异性为97．5％，灵敏度92．9％；苯唑西林纸片法筛选出44株MRSA，其中36株mecA基因阳性．方法特异性为81．8％．灵敏度85．7％。MRSA对青霉素、苯唑西林100％耐药，对万古霉素全部敏感．对红霉素、头孢唑林、克林霉素、氨苄西林／舒巴坦、头孢呋辛、左氧氟沙星、奈替米星呈不同程度耐药。结论头孢西丁纸片扩散法检测MRSA特异性和灵敏度优于苯唑西林纸片扩散法。MRSA具有多重耐药性．须加强其对抗生素的耐药性监测。     

Susceptibility patterns of Streptococcus pneumoniae isolates in North America (2002-2003): contemporary in vitro activities of amoxicillin/clavulanate and 15 other antimicrobial agents

A contemporary (2002-2003) national collection of 2100 strains of Streptococcus pneumoniae obtained from 30 sites in the nine United States (US) census regions were tested to determine the comparative antimicrobial properties of amoxicillin/clavulanate and 15 other antimicrobials. The rank order of antimicrobials with the lowest susceptibility rates was: penicillin (67.9%)or=41.1%), trimethoprim/sulphamethoxazole (38.9%), tetracyclines (22.2%) and clindamycin (10.0%). Geographical variation in the susceptibility patterns among US census zones was present with lowest penicillin and erythromycin susceptibility noted for West South Central and West North Central zones (or=+0.9%), sinus isolates (+2.7%), middle ear fluid isolates (+5.5%), penicillin-resistant strains (>or=+5.8%) and strains from patients <2 years of age (>or=+2.4%). Local and global surveillance studies of common respiratory pathogens such as S. pneumoniae remain instrumental to guide clinicians in appropriate empirical treatments and to emphasize the need for prudent antimicrobial use.     

In vitro activities of the oxazolidinone compounds linezolid (PNU-100766) and eperzolid (PNU-100592) against middle ear isolates of Streptococcus pneumoniae.

Two hundred and sixteen isolates of Streptococcus pneumoniae recovered between 1994 and 1996 from the middle ears of children with acute otitis media were tested for their susceptibility to penicillin, erythromycin, clindamycin and the oxazolidinones, linezolid (PNU-100766) and eperezolid (PNU-100592). There were 116 isolates from the Children's Hospital of Pittsburgh and 100 isolates from a national collection. Eighty percent of the local strains were susceptible to penicillin (MIC < 0.1 mg/l); 20% of the local strains and all of the national strains had reduced susceptibility to penicillin. All strains of S. pneumoniae tested had an MIC < 2.0 mg/l for both oxazolidinones. A regional difference was noted in the frequency of resistance to erythromycin with local isolates being more susceptible than isolates from the national collection. This difference was most pronounced among the high-level penicillin-resistant strains of S. pneumoniae.     

Antimicrobial resistance and serotype distribution of Streptococcus pneumoniae isolates from Crete, Greece

Susceptibility to 14 antibiotics was determined for 125 clinical isolates of Streptococcus pneumoniae collected over a 3-year period in Crete, Greece. Twenty-three isolates (18.4%) showed intermediate resistance and 15 (12%) high-level resistance to penicillin. Erythromycin, chloramphenicol, tetracycline, trimethoprim-sulphamethoxazole and sparfloxacin resistance rates were 16.8, 10.4, 19.2, 24.8 and 9.6%, respectively. Multiple resistance was observed in 22 strains. Vancomycin and levofloxacin were the most active agents tested. The most prevalent serotype among penicillin-susceptible pneumococci was 14, followed by 9, 7 and 1, while among penicillin-intermediate or -resistant strains serotype 23 was predominant followed by 19 and 9. These results show that as well as a high level of penicillin resistance in this region, some strains are also resistant to other antibiotics and may show multi-drug resistance.     

耐甲氧西林金黄色葡萄球菌耐药性分析

目的了解耐甲氧西林金黄色葡萄球菌(MRSA)对各种抗菌药物的耐药性。方法 对30株MRSA进行药敏实验,药敏实验采用VITEK32全自动微生物分析仪GPS药敏板。结果 在测试的14种抗菌药物中,万古霉素未出现耐药菌株,对呋喃妥因、利福平、复方磺胺甲口恶唑耐药率低(分别为6.7%、10.0%、20.0%)。对氯霉素耐药率为53.3%,对克林霉素、红霉素、庆大霉素、四环素、左氧氟沙星耐药率均在90.0%以上。对氨苄西林、头孢唑啉、苯唑西林、青霉素则是全耐药。结论 应加强抗菌药物的合理应用,减少MRSA耐药事件的发生。     

The Sentinel Project: an update on the prevalence of antimicrobial resistance in community-acquired respiratory Streptococcus pneumoniae and Haemophilus spp. in Italy

A total of 460 Streptococcus pneumoniae and Haemophilus spp. collected from respiratory infections during 2000 was tested for their susceptibility to 15 selected antibiotics. Overall, penicillin resistance among pneumococci was 10.5%, while lack of susceptibility to macrolides, co-trimoxazole, tetracycline and chloramphenicol reached 35.2%, 26.2%, 22.6% and 6.0%, respectively. Amoxicillin/clavulanic acid and levofloxacin were the most potent compounds (100% and 99.9% susceptible strains, respectively). Among isolates of Haemophilus influenzae and Haemophilus parainfluenzae, beta-lactamase production (12.5% and 10%, respectively), and co-trimoxazole (19.9% and 40.0%) and clarithromycin (11.2% and 40.0%) resistance were the prevalent threats. This study confirms the trend observed in Italy since 1992: macrolide resistance among respiratory microorganisms is increasing, while several drugs including amoxicillin/clavulanic acid, third generation injectable cephalosporins and fluoroquinolones remain active on the great majority of these pathogens.