厦门海沧566例下呼吸道感染患儿痰培养阳性标本病原菌构成及耐药分析

目的 了解厦门海沧患儿下呼吸道感染的病原菌构成及其耐药情况。方法 回顾性分析我院儿科566例下呼吸道感染患儿痰培养阳性标本的细菌培养结果，统计病原菌株的主要构成及其耐药情况。结果 共分离病原菌602株，其中革兰阳性菌304株，革兰阴性菌292株，真菌6株，分离数量前5的病原菌为肺炎链球菌、流感嗜血杆菌、金黄色葡萄球菌、卡他莫拉菌和大肠埃希菌。病原菌对常用抗菌药均表现出一定程度的耐药，其中肺炎链球菌对红霉素和四环素耐药率高达90%以上；金黄色葡萄球菌主要对青霉素、红霉素、克林霉素耐药；流感嗜血杆菌和卡他莫拉菌对氨苄西林、头孢克洛、头孢呋辛耐药率较高。结论 厦门海沧患儿下呼吸道感染的病原菌以肺炎链球菌和流感嗜血杆菌为主，各主要病原菌对常用抗菌药物均有不同程度的耐药。     

6312例学前儿童流感嗜血杆菌和卡他莫拉菌以及肺炎链球菌感染的血清型分型及其耐药状况分析

目的:分析洛阳地区学前儿童流感嗜血杆菌、卡他莫拉菌及肺炎链球菌感染的血清型分型及耐药状况.方法:选取医院2017年1月-2019年12月儿科6岁以下呼吸道感染患儿6312例病历资料,分析其病原菌培养、血清型鉴定和药敏试验结果对用药的影响.结果:6312例患儿痰标本中,分离出8936株病原菌,其中流感嗜血杆菌3802株(占42.54％)、卡他莫拉菌2463株(占27.56％)、肺炎链球菌1346株(占20.00％)和其他菌株1483株(占9.90％);肺炎链球菌血清型分型以19A型(30.87％)、6A型(25.50％)为主,其疫苗接种覆盖率(percent vaccine coverage rate,PVC 7)为57.16％,PVC 11覆盖率为60.01％,PVC 13覆盖率为75.00％;流感嗜血杆菌对复方磺胺甲噁唑和氨苄西林的耐药率均较高,对头孢曲松、头孢他啶、头孢噻肟和美罗培南则无耐药;卡他莫拉菌对阿奇霉素、红霉素和克拉霉素的耐药率较高,对阿莫西林-克拉维酸钾则无耐药;肺炎链球菌对克林霉素、红霉素、四环素和复方磺胺甲噁唑的耐药率较高,对非口服青霉素和万古霉素则无耐药.结论:洛阳地区学前儿童流感嗜血杆菌、卡他莫拉菌及肺炎链球菌感染中,致病菌以流感嗜血杆菌为主,其次为卡他莫拉菌、肺炎链球菌感染,肺炎链球菌血清型分型以19A型、6A型为主,PVC 13覆盖率较高,且流感嗜血杆菌、卡他莫拉菌及肺炎链球菌对头孢噻肟均无耐药,临床可根据其药敏试验结果,合理选用抗菌药物治疗,确保其临床疗效.     

2014—2018年天津市儿童医院化脓性脑膜炎病原菌分布及耐药性分析

目的 分析2014—2018年天津市儿童医院化脓性脑膜炎病原菌的分布和耐药性,为临床合理应用抗菌药物提供依据。方法 收集2014年1月—2018年12月在天津市儿童医院住院,经脑脊液或血液培养细菌阳性的化脓性脑膜炎患儿121例,统计并分析化脓性脑膜炎病原菌的分布和耐药性。结果 化脓性脑膜炎患儿的年龄分布主要为<28 d和28 d～1岁,构成比分别为26.5%、41.3%。共分离出121株病原菌,其中革兰阳性菌85株,占70.2%,主要为肺炎链球菌、表皮葡萄球菌和无乳链球菌;革兰阴性菌36株,占29.8%,主要为大肠埃希菌、肺炎克雷伯菌和铜绿假单胞菌。不同年龄段化脓性脑膜炎患儿感染的病原菌不同。肺炎链球菌、表皮葡萄球菌和无乳链球菌均对利奈唑胺和万古霉素完全敏感。肺炎链球菌对左氧氟沙星和莫西沙星也完全敏感,对克林霉素和红霉素的耐药率均高达95.6%;表皮葡萄球菌对苄青霉素、苯唑西林和红霉素的耐药率较高;无乳链球菌对克林霉素和红霉素耐药率较高,对其他抗菌药物均完全敏感。大肠埃希菌、肺炎克雷伯菌和铜绿假单胞菌均对阿米卡星完全敏感。大肠埃希菌对呋喃妥因也完全敏感,对氨苄西林、哌拉西林的耐药率高达80%;肺炎克雷伯菌对妥布霉素和环丙沙星也完全敏感,对氨苄西林的耐药率高达80.0%;铜绿假单胞菌对头孢他啶、庆大霉素和妥布霉素也完全敏感,对氨苄西林、氨苄西林/舒巴坦、头孢唑林、头孢呋辛、头孢替坦、头孢曲松、复方新诺明和呋喃妥因的耐药率均高达100.0%,对其他抗菌药物的耐药率均为25.0%。结论 不同年龄段化脓性脑膜炎患儿感染病原菌不同,临床经验用药时应根据患儿发病年龄和耐药性情况选择不同的抗菌药物,提高治疗的针对性。     

南宁地区儿童呼吸道感染苛养菌分布及耐药性分析

目的：了解南宁地区儿童呼吸道感染苛养菌分布及耐药性特点。方法：对2013年8月至2014年7月在广西壮族自治区妇幼保健院住院的呼吸道感染患儿5 235例痰标本苛养菌培养及药敏结果进行回顾分析。结果：5 235例标本共分离出肺炎链球菌226例、流感嗜血杆菌126例、副流感嗜血杆菌34例和卡他布兰汉菌21例。肺炎链球菌对万古霉素均敏感,对喹诺酮类、青霉素、氯霉素、头孢菌素类、酶抑制剂类较敏感,对阿奇霉素、复方磺胺甲恶唑、红霉素、克林霉素、四环素耐药率超过90%。流感嗜血杆菌、副流感嗜血杆菌、卡他布兰汉菌对头孢噻肟、阿莫西林/克拉维酸、亚胺培南敏感,对氨曲南耐药率均超过60%。流感嗜血杆菌、副流感嗜血杆菌、卡他布兰汉菌产β-内酰胺酶检出率分别为40.48%、38.24%和61.90%（P<0.05）。结论：儿童呼吸道感染苛养菌以肺炎链球菌为主,有其独特耐药谱,临床应明确病原学诊断,根据药敏结果选用敏感抗菌药物。     

2014—2018年天津市宝坻区人民医院感染性疾病病原菌的分布及耐药性分析

目的 分析2014—2018年天津市宝坻区人民医院感染性疾病病原菌的分布及耐药性,为临床抗菌药物的合理应用提供依据。方法 回顾性分析2014—2018年天津市宝坻区人民医院感染性疾病病原菌的分布及耐药性。结果 共分离出病原菌13 614株,标本主要来源于痰液、分泌物、尿液、血液,分别占38.10%、19.00%、14.31%、13.41%。革兰阴性杆菌共8 808株,占64.70%,革兰阳性球菌3 796株,占27.88%,革兰阳性杆菌76株,占0.56%;革兰阴性球菌7株,占0.05%,真菌927株,占6.81%。不同部位标本分离的病原菌有所不同。大肠埃希菌、肺炎克雷伯菌对氨苄西林耐药率较高,对美罗培南、亚胺培南、哌拉西林/他唑巴坦、阿米卡星的耐药率低于5%以下;铜绿假单胞菌对头孢唑林、呋喃妥因、复方新诺明、氨苄西林、头孢呋辛钠、头孢曲松的耐药率均在90%以上,对阿米卡星的耐药率在10%以下;鲍曼不动杆菌对阿米卡星耐药率在5%以下,对大部分药物的耐药率较高。金黄色葡萄球菌、表皮葡萄球菌对万古霉素、利奈唑胺、替加环素无耐药,对青霉素、红霉素耐药率较高;肺炎链球菌对克林霉素、红霉素耐药率较高,对万古霉素、利福平无耐药;屎肠球菌对克林霉素、红霉素、青霉素耐药率较高,对替加环素无耐药,对万古霉素、利奈唑胺耐药率为1.98%。结论 天津市宝坻区人民医院分离的病原菌对抗菌药物有不同程度的耐药,加强病原学检查及耐药监测有助于临床合理选择抗菌药。     

Mohnarin 2008年度报告:链球菌、嗜血菌及黏膜炎莫拉菌耐药性监测

目的 了解我国临床分离链球菌、嗜血菌及黏膜炎莫拉菌对抗菌药物的耐药状况.方法 采用纸片法、MIC法或E-test法测定细菌药物敏感性,使用WHONET5.4软件进行数据分析,对卫生部全国细菌耐药性监测网(Mohnarin)所属89家三级甲等医院2008年1月1日至2008年12月31日分离的链球菌、嗜血菌及黏膜炎莫拉菌对药物敏感性进行分析.结果 共分离链球菌5138株,包括肺炎链球菌1456株、草绿色链球菌1147株、β-溶血链球菌1259株和其它链球菌1276株;共分离嗜血菌2360株,包括流感嗜血菌1363株、副流感嗜血菌547株及其它嗜血菌450株:共分离黏膜炎莫拉菌190株.耐药实验显示链球菌主要对大环内酯类与克林霉素耐药,未发现对万古霉素和利奈唑胺耐药株,耐青霉素肺炎链球菌的发生率为3.8%;嗜血菌对氨苄西林耐药率超过40%,对大环内酯类和复方磺胺甲噁唑敏感率低于50%黏膜炎莫拉菌对氨苄西林的敏感率为38.3%,对二、三代头孢菌素、氨基糖苷及喹诺酮类药物较为敏感.结论 青霉素可以作为社区获得性肺炎经验治疗药物;临床慎重使用大环内酯类和克林霉素治疗链球菌感染;嗜血菌、黏膜炎莫拉菌对广谱青霉素类耐药率较高.     

呼吸道感染患儿咽部病原菌分布及耐药性分析

目的 了解儿童上呼吸道感染病原菌情况及耐药性,以便指导临床合理用药.方法 对2012年1月～2013年4月本院住院儿科1022例上呼吸道感染儿童咽拭子标本进行培养及鉴定.采用法国ATB自动细菌鉴定仪及MIC药敏板进行细菌鉴定和药敏试验,β-内酰胺酶试验采用头孢硝噻吩纸片法,耐甲氧西林金黄色葡萄球菌（MRSA）采用头孢西丁纸片法检测.结果 检出病原菌296株,其中金黄色葡萄球菌、肺炎链球菌及流感嗜血杆菌检出率分别为13.70％、5.97％、5.19％分列前三位.金黄色葡萄球菌对常用抗菌药物耐药率为青霉素95.7％、红霉素80.0％、左氧氟沙星4.3％;肺炎链球菌对常用抗菌药物耐药率为青霉素9.84％、红霉素54.1％、左氧氟沙星3.3％;流感嗜血杆菌对常用抗菌药物耐药率为氨苄西林34.0％、阿奇霉素0、左氧氟沙星0,复方新诺明56.6％、阿莫西林/克拉维酸5.7％.结论 儿童上呼吸道感染病原菌分布广泛,检出致病菌有一定的耐药率,只根据经验用药不能很好地控制病情,临床应重视根据病原菌感染情况及药敏试验结果,进行耐药性监测和合理用药.     

2017-2018年南京市儿童医院儿科重症监护病房感染病原菌的分布及耐药性分析

目的 了解南京市儿童医院儿科重症监护病房（PICU）病原菌的分布及耐药性,为临床合理选用抗菌药物提供依据。方法 对2017年1月-2018年12月南京市儿童医院PICU住院患儿送检标本所分离的病原菌及其耐药性进行回顾性分析。结果 共分离出306株病原菌,主要来自痰液,共191例,构成比为62.41%。革兰阳性菌120株,构成比为39.21%,主要为金黄色葡萄球菌、肺炎链球菌和屎肠球菌;革兰阴性菌166株,构成比为54.25%,主要为肺炎克雷伯菌、流感嗜血杆菌、大肠埃希菌、铜绿假单胞菌和鲍曼不动杆菌;真菌20株,构成比为6.54%。金黄色葡萄球菌对环丙沙星、替加环素、万古霉素、左氧氟沙星、喹努普汀/达福普汀、利福平、利奈唑胺、莫西沙星和庆大霉素完全敏感;金黄色葡萄球菌对青霉素G的耐药率高达93.88%。肺炎链球菌对克林霉素、红霉素完全耐药,耐药率为100.00%,未发现对氯霉素、青霉素G、万古霉素的耐药菌株。屎肠球菌对氨苄西林和青霉素G完全耐药,耐药率为100.00%,未发现对喹努普汀/达福普汀、利奈唑胺、替加环素和万古霉素的耐药菌株。肺炎克雷伯菌对氨苄西林完全耐药,耐药率为100.00%,未发现对左氧氟沙星、环丙沙星的耐药菌株;流感嗜血杆菌对头孢曲松和美洛培南的耐药率较低,均为3.70%。大肠埃希菌对阿米卡星完全敏感。铜绿假单胞菌对左氧氟沙星、环丙沙星、妥布霉素、庆大霉素、阿米卡星完全敏感。鲍曼不动杆菌除了对头孢噻肟完全耐药外,对其他抗菌药物的耐药率均较低,且对左氧氟沙星完全敏感。结论 南京市儿童医院PICU医院感染菌耐药性严重,应加强病原菌耐药性的监测,为临床合理应用抗菌药物提供依据。     

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。     

2018年四川省儿童患者细菌耐药监测分析

摘要：目的 了解2018年四川省儿童患者主要病原菌分布及对常用抗菌药物耐药性,为临床合理选择抗菌药物提供依据。方法 收集2018年全国细菌耐药监测网四川省成员单位报告的儿童患者病原菌数据并进行分析总结。结果 2018年共分离出细菌46387株,其中革兰阳性菌19012株(占41.0%),以肺炎链球菌、金黄色葡萄球菌和凝固酶阴性葡萄球菌为主,检出率分别是17.3%、15.7%和2.1%;革兰阴性菌27375株(占59.0%),主要是流感嗜血菌、大肠埃希菌和黏膜炎莫拉菌,检出率分别是21.2%、10.4%和8.3%。非脑脊液标本分离的肺炎链球菌对红霉素的耐药率高达95.9%。耐甲氧西林金黄色葡萄球菌的检出率为26.7%,耐甲氧西林凝固酶阴性葡萄球菌的检出率为79.1%,未发现万古霉素和利奈唑胺耐药肺炎链球菌和葡萄球菌。粪肠球菌对万古霉素的耐药率为0.6%,未发现替考拉宁耐药的粪肠球菌;屎肠球菌对万古霉素的耐药率为0.6%,对替考拉宁的耐药率为2.1%。流感嗜血菌对氨苄西林、复方磺胺甲噁唑以及头孢克肟的耐药率高。黏膜炎莫拉菌对阿奇霉素的非敏感率为72.5%。肺炎克雷伯菌对亚胺培南、美罗培南耐药率分别为7.7%和11.6%。结论 2018年四川省儿童细菌感染的主要病原菌中,耐红霉素的肺炎链球菌、耐甲氧西林凝固酶阴性葡萄球菌、耐氨苄西林的流感嗜血菌以及耐碳青霉烯的肺炎克雷伯菌检出率高,需加强感染防控。     

泸州16 418例住院儿童下呼吸道感染细菌病原分布及耐药性分析

目的:了解泸州地区儿童下呼吸道感染细菌病原的分布及耐药情况。方法:采用回顾性研究方法,收集2013 年7 月至 2018 年6 月因下呼吸道感染入住西南医科大学附属医院儿科的患儿痰液细菌培养及药敏试验结果16 418 份,分析常见细菌的 耐药情况。结果:16 418 份痰标本中,5 298 份(32. 3%) 检出细菌或真菌( 真菌相对较少,暂不重点讨论)。其中,革兰阳性菌 2 076 株(39. 2%),主要为金黄色葡萄球菌1 148 株、肺炎链球菌848 株等;革兰阴性菌2 766 株(52. 2%),主要为大肠埃希菌 858 株、肺炎克雷伯菌857 株等。金黄色葡萄球菌对头孢西丁、氨苄西林、青霉素、克林霉素、红霉素的耐药率较高( >60%),对 苯唑西林、头孢曲松敏感率较高(>74%)。肺炎链球菌对克林霉素、红霉素的耐药率高( >80%),对碳青霉烯类抗菌药物、青霉 素、头孢呋辛、头孢曲松高度敏感(>98%)。暂未发现对利奈唑胺及万古霉素耐药的金黄色葡萄球菌或肺炎链球菌。大肠埃希 菌、肺炎克雷伯菌、铜绿假单胞菌对第三代、第四代头孢菌素的敏感率均<67%。铜绿假单胞菌对碳青霉烯类抗菌药物的耐药率 较高(16. 9%~34. 6%)。结论:泸州地区儿童下呼吸道感染细菌病原以革兰阴性菌为主,临床应同时监测细菌对常用抗菌药物 的耐药性和敏感性,促进抗菌药物合理应用,及时控制细菌病原的传播。     

Antimicrobial resistance of Streptococcus pneumoniae and Haemophilus influenzae in Sao Paulo, Brazil from 1996 to 2000

This study was undertaken to assess the in vitro activity of several antimicrobial agents against Brazilian isolates of Streptococcus pneumoniae and Haemophilus influenzae from 1996 to 2000. The antibiotics used were penicillin, amoxicillin/clavulanic acid (A/C), ampicillin, amoxicillin, cefaclor, cefdinir, cefixime, cefprozil, ceftriaxone, cefuroxime, azithromycin, clarithromycin, erythromycin, ciprofloxacin, levofloxacin, ofloxacin, chloramphenicol, clindamycin, doxycycline and trimethoprim/sulphamethoxazole (T/S). MICs were determined by the National Committee for Clinical Laboratory Standards (NCCLS) method and interpreted using NCCLS and PK/PD breakpoints. For S. pneumoniae 80.0% were penicillin susceptible, 18.3% intermediate, 1.7% resistant; most active agents were amoxicillin, A/C, ceftriaxone and levofloxacin; T/S was the least active agent. Beta-lactamase was produced by 13.7% of H. influenzae. All were susceptible to A/C, cefdinir, cefixime, ceftriaxone and quinolones. The least active agents were T/S and macrolides.     

新生儿败血症病原菌分布及耐药性分析

目的：分析我院新生儿早发型与晚发型败血症的病原菌分布及抗生素耐药情况,检测感染凝固酶阴性葡萄球菌（CoNS）和耐甲氧西林凝固酶阴性葡萄球菌（MRCN）耐药情况,为抗CoNS和抗MRCN感染治疗提供指导。方法：选择2010年至2015年我院儿科收治、血培养阳性并符合新生儿败血症诊断标准的患儿138例,对致病菌及药物敏感试验进行回顾性分析。结果：血培养检出病原菌24种共140株（其中136例为单一菌株感染,2例为双重菌株感染）,以CoNS的检出率最高,为80.0%（112/140）。140株病原菌中检出MRCN 81株,耐甲氧西林金黄色葡萄球菌（MRSA）1株。81株MRCN的药敏试验显示对青霉素、氨苄西林、阿莫西林/克拉维酸、头孢唑林、红霉素、亚胺培南、克林霉素的耐药率分别为93.8%（76/81）、86.4%（70/81）、81.5%（66/81）、75.3%（61/81）、72.8%（59/81）、64.2%（52/81）和45.7%（37/81）,未发现对万古霉素和利奈唑胺耐药菌株。结论：我院新生儿败血症病原菌以MRCN检出率高,临床应合理应用抗生素,以提高临床效果。     

Patterns of isolation of common gram positive bacterial pathogens and their susceptibilities to antimicrobial agents in Jimma Hospital

Gram positive bacteria are frequently emerging as antibiotic resistant pathogens, causing serious infections than ever before in the ill and debilitated patients. The pattern of isolation and the antimicrobial susceptibilities of common Gram positive cocci including Staphylococcus aureus, coagulase negative staphylococcus (CoNS), Streptococcus pyogenes, Enterococcus species and Streptococcus pneumoniae was investigated between January 1997 and June 2000 in Jimma Hospital. Of the 500 specimens collected from children and adults, 116 (23.2%) consisted of one or more of the above organisms. The following strains: Staphylococcus aureus, 47 (40.5%), CoNS, 36 (31.0%), Streptococcus pneumoniae, 26 (22.4%) Streptococcus pyogenes, 5 (4.3%) and Streptococcus faecalis, 2(1.7%) were isolated from different specimens including pus, sputum, urine, stool, blood and oro/nasopharyngeal swabs of patients. The in vitro activities of 14 different antibiotics including penicillin G, ampicillin, cloxacillin, cephalothin, gentamicin, kanamycin, tetracycline, chloramphenicol, erythromycin, trimethoprim-sulfamethoxazole, streptomycin, methicillin, vancomycin and clindamycin was determined against the clinical bacterial isolates. The antimicrobial activities were evaluated by agar diffusion technique using Mueller-Hinton agar according to NCCLS recommendations. The majority of the pathogens, 59(50.9%) were recovered from upper respiratory tract infections and 17 (14.6%) from the lower respiratory tract. The resistance patterns of S. aureus, CoNS, S. pneumoniae and enterococci to penicillin was 91.5%, 94.4%, 7.7% and 100% respectively. Penicillin, ampicillin and cloxacillin showed low effects (< 60%) on both S. aureus and CoNS. Multi-drug resistance was observed in all the gram-positive isolates, especially higher in staphylococcus species. All isolates of S. aureus (100%) were susceptible to vancomycin, clindamycin and gentamicin. In order to reduce morbidity and mortality due to antibiotic resistance susceptibility testing should be performed for the proper management of bacterial infections. This entails the need for national surveillance to monitor antibiotic resistance in bacteria by susceptibility testing using reliable methods.     

哺乳期乳腺脓肿病原菌分布及耐药性研究

目的分析哺乳期乳腺脓肿病原菌分布及耐药状况,指导临床用药。方法收集111份乳腺脓肿脓汁标本进行细菌分离鉴定及药敏试验,用法国梅里埃公司生产的API鉴定系统进行细菌菌株鉴定,用K-B纸片扩散法作药敏试验。结果培养出68株病原菌,金黄色葡萄球菌61株,占89.7%,其中耐甲氧西林金黄色葡萄球菌(MR-SA)为13株;表皮葡萄球菌2株,占2.9%,草绿色链球菌、路邓葡萄球菌、肺炎克雷伯菌、粘质沙雷菌、产酸克雷伯菌各1株,均占1.5%。金黄色葡萄球菌呈现多重耐药趋势,对青霉素、红霉素、克林霉素耐药率分别为88.5%、52.5%、44.3%,对磷霉素、庆大霉素、左氧氟沙星、万古霉素、替考拉宁及复方磺胺甲恶唑高度敏感;其中MRSA对青霉素、头孢唑啉、氨苄西林+舒巴坦、苯唑西林的耐药率达100%,对红霉素、克林霉素耐药率亦达92.3%。结论哺乳期乳腺脓肿细菌感染主要为金黄色葡萄球菌;治疗哺乳期乳腺脓肿不宜选用青霉素,红霉素、克林霉素不宜作为治疗的常规用药,对于MRSA头孢唑啉、氨苄西林+舒巴坦、苯唑西林亦不能作为治疗的常规药物,抗菌药物的选择应以药敏结果为指导。     

Susceptibility patterns of bacterial isolates from hospitalised patients with respiratory tract infections (MOXIAKTIV Study)

The objective of this study was to determine: (i) the prevalence of resistance in current clinical isolates of Streptococcus pneumoniae, Staphylococcus aureus, Haemophilus influenzae, Moraxella catarrhalis and Klebsiella pneumoniae; (ii) the prevalence of production of extended-spectrum beta-lactamases (ESBLs) and methicillin resistance in S. aureus; and (iii) regional differences in the prevalence of ESBL production and clonality of K. pneumoniae isolates. Pathogens causing respiratory tract infections in hospitalised patients were prospectively collected from all over Germany. Drugs tested by Etest included moxifloxacin, levofloxacin, amoxicillin/clavulanic acid, cefuroxime, clarithromycin and penicillin G. ESBL production by K. pneumoniae was determined using cefotaxime/ceftazidime +/- clavulanic acid. Deutsches Institut für Normung (German Institute for Standardisation)/European Committee on Antimicrobial Susceptibility Testing (DIN/EUCAST) breakpoints were used where applicable. Overall, 1859 pathogens were analysed. For all species tested the fluoroquinolones achieved the highest overall susceptibility rate (92.8%) compared with clarithromycin (60.5%), amoxicillin/clavulanic acid (85.7%) and cefuroxime (89.6%). From 438 K. pneumoniae isolates, 13.0% produced an ESBL. The ESBL prevalence was 38.8% in Eastern Germany with a trend towards clonality in some centres, but ranged from 4.7% to 7.1% in Southern, Northern and Western Germany. Among the methicillin-susceptible S. aureus isolates, 10.1% were moxifloxacin- and levofloxacin-resistant. Of the S. pneumoniae isolates, 99.3% were moxifloxacin- and levofloxacin-susceptible, 93.9% were penicillin G-susceptible and 85.7% were clarithromycin-susceptible. With a MIC90 value (minimal inhibitory concentration for 90% of the isolates) of 0.19 mg/L, moxifloxacin was more potent than levofloxacin (MIC90 = 1 mg/L) against S. pneumoniae. Haemophilus influenzae and M. catarrhalis were almost 100% susceptible to the quinolones; 100% of the M. catarrhalis but only 4.5% of the H. influenzae strains were clarithromycin-susceptible. Moxifloxacin was the most active agent amongst the drugs tested, in particular against Gram-positive pathogens.     

泌尿系感染患儿病原菌的分布及对常用抗菌药物的敏感性

目的研究泌尿系感染患儿病原菌的分布及对常用抗菌药物的敏感性情况,从而为临床合理使用抗菌药物提供科学依据。方法选取从2018年1至12月泌尿系感染患儿100例作为观察对象。采用法国生物梅里埃公司VITEK-compact检测患儿病原菌的分布情况,并进行病原菌的药敏试验。结果100例泌尿系感染患儿病原菌分布情况按照占比从高到低依次为大肠埃希菌51.00%、肺炎克雷伯菌12.00%、粪肠球菌10.00%、屎肠球菌7.00%、铜绿假单胞菌4.00%、奇异变形杆菌3.00%、摩氏摩根菌2.00%、金黄色葡萄球菌1.00%和白色假丝酵母菌1.00%。大肠埃希菌对哌拉西林、阿莫西林克拉维酸、哌拉西林他唑巴坦、头孢噻肟、头孢他啶和亚胺培南的耐药率分别为70.59%、5.88%、3.92%、41.18%、31.37%和0。肺炎克雷伯菌对哌拉西林、阿莫西林克拉维酸、哌拉西林他唑巴坦、头孢噻肟、头孢他啶和亚胺培南的耐药率分别为41.67%、25.00%、16.67%、33.33%、16.67%和0。粪肠球菌对氨苄西林、庆大霉素、环丙沙星、呋喃妥因、利奈唑胺和万古霉素的耐药率分别为10.00%、40.00%、30.00%、0、10.00%和0。结论泌尿系感染患儿病原菌主要以大肠埃希菌、肺炎克雷伯菌、粪肠球菌为主,其中大肠埃希菌、肺炎克雷伯菌均对亚胺培南有较高的敏感性,粪肠球菌对呋喃妥因、万古霉素的敏感性较高,值得临床重点关注。     

儿童心脏术后下呼吸道分离菌的分布及耐药性分析

目的 回顾性分析心血管病医院儿童心脏术后下呼吸道分离菌的分布及其耐药特点,为临床治疗提供用药参考。方法 对2014年1月1日-2016年12月31日术后送检的痰标本进行培养,对分离出的致病菌做鉴定及药敏实验。结果 共分离出762株致病菌,革兰阴性菌占69.29%,革兰阳性菌占21.65%,真菌占7.87%,排名前5位的细菌为铜绿假单胞菌(138株)、大肠埃希菌(95株)、肺炎克雷伯菌(95株)、金黄色葡萄球菌(66株)和肺炎链球菌(64株)。药敏结果显示非发酵菌对氨基糖苷类的耐药率为0.72%~8.57%但对碳青霉烯类≥40%;肺炎克雷伯菌对碳青霉烯类的耐药率为16.13%~24.21%,远高于大肠埃希菌和阴沟肠杆菌的0~2.44%;阴沟肠杆菌的整体耐药率低于大肠埃希菌和肺炎克雷伯菌;金黄色葡萄球菌中MRSA占29.23%,其对青霉素的耐药率为98.41%,对万古霉素、利奈唑胺、替加环素的耐药率为0;肺炎链球菌对青霉素的耐药率为14.06%,对万古霉素、利奈唑胺的耐药率为0。结论 儿童心脏术后下呼吸道分离菌以革兰阴性菌为主;碳青霉烯类抗生素对非发酵菌的高耐药率值得高度重视;肺炎克雷伯菌对碳青霉烯类抗生素的耐药率有上升趋势。     

Eradication of pathogens from the nasopharynx after therapy of acute maxillary sinusitis with low- or high-dose amoxicillin/clavulanic acid

The growing resistance of Streptococcus pneumoniae to penicillin can be overcome by increasing the dose of the penicillin administered. This generated the recommendation that the adult dose of amoxicillin for the treatment of acute maxillary sinusitis (AMS) be increased from 1.5 g/day to 4.0 g/day. The objective of this study was to investigate whether the higher dose of amoxicillin is more effective than the previously recommended dose in eradicating S. pneumoniae from the nasopharynx of patients who present with AMS. Nasopharyngeal cultures obtained from 58 patients with AMS were studied: 30 received amoxicillin 1.5 g/day given in divided doses three times a day for 10 days (amoxicillin/clavulanic acid 4:1 formulation) and 28 were treated with amoxicillin 4.0 g/day given in divided doses twice a day for 10 days (amoxicillin/clavulanic acid 16:1 formulation). Seventy-one potentially pathogenic organisms were isolated: S. pneumoniae (27 isolates), Haemophilus influenzae non-type b (25), Moraxella catarrhalis (5), Streptococcus pyogenes (5) and Staphylococcus aureus (9). The number of S. pneumoniae isolates in the 1.5 g/day group was reduced from 14 to 9 (2 intermediately resistant and 3 highly resistant). In contrast, the number of S. pneumoniae isolates in the 4.0 g/day group was reduced from 13 to 2 (1 highly resistant) (P<0.05). No differences were noted in the eradication rate of other groups of isolates, which were all susceptible to amoxicillin/clavulanic acid. These data illustrate the superiority of 4.0 g/day amoxicillin/clavulanic acid compared with 1.5 g/day amoxicillin/clavulanic acid in the eradication of S. pneumoniae from the nasopharynx.