连续五年1605株小于5岁儿童来源肺炎链球菌耐药性分析

目的 了解深圳市宝安区小于5岁儿童肺炎链球菌抗生素耐药性特征,为临床用药提供依据。方法E-test法检测SP对青霉素和头孢曲松的MIC,K-B法检测其他抗生素的敏感性,采用CLSI 2008年标准判断抗生素敏感性,用Whonet软件统计分析2009~2013年深圳市宝安区妇幼保健院临床分离自5岁以下儿童肺炎链球菌（SP）相关性疾病（PD）来源的SP抗生素耐药性。结果 近五年共分离1605株SP,多重耐药菌比例高达86.8%,最常见的耐药模式为：红霉素＋克林霉素＋复方新诺明,对万古霉素和左氧氟沙星的敏感性分别为100.0%和98.8%;对青霉素和头孢曲松的MIC50/90分别为1/2和0.75/2,连续五年MIC50稳定波动,MIC90略有上升趋势;按非脑膜炎标准未检测出耐青霉素SP（PRSP）,按脑膜炎标准和口服标准对青霉素耐药性显著增加分别为88.6%、39.2%;按脑膜炎标准和非脑膜炎标准,SP对头胞曲松的耐药性分别为25.6%和5.5%。结论深圳市宝安区小于5岁儿童SP多重耐药比例高,应避免使用红霉素、克林霉素和复方新诺明治疗PD,非脑膜炎感染SP应尽量选用青霉素,避免选择压力,保护三代头孢菌素敏感性,脑膜炎感染SP则需参考药敏结果选择敏感抗生素。

Analysis of Antimicrobial Resistance of 1605 Streptococcus Pneumoniae Isolates from Children Less than 5 Years Old for Five Consecutive Years

Objective To analyze streptococcus pneumoniae （SP）antimicrobial resistance in children less than 5 years old in Shenzhen Bao＇an district. Methods E-test method was used for antimicrobial resistance of penicillin and ceftriaxone. K-B method was used for other antimicrobial sensitivity. Breakpoints were based on the 2008 criteria of the Clinical and Laboratory Standards Institute （CLSI）. Whonet software analysis was used to analyzed the antimierobial resistance of SP in children less than 5 years old from 2009 to 2013 in Baohn Maternity and Child Health Hospital. Results E-test method was used for antimicrobial resistance of penicillin and ceftriaxone. K-B method was used for other antimicrobial sensitivity. Breakpoints were based on the 2008 criteria of the Clinical and Laboratory Standards Institute （CLSI）. Whonet software analysis was used to ana- lyzed the antimicrobial resistance of SP in children less than 5 years old from 2009 to 2013 in Bao~m Maternity and Child Health Hospital. Conclusion MDRSP ratio is high in children less than 5 years old in local place. Something should be done to avoid the use of erythromycin, elindamycin and trimethoprim-sulphamethoxazole in treating PD. Penicillin is good choice for nonmeningitis SP infection. For meningitis infection SP, antimicrobial susceptibility results is more reliable.