2010～2012年呼吸道嗜血杆菌的分离及耐药性监测

目的了解2010～2012年蚌埠医学院第一附属医院呼吸道嗜血杆菌（Haemophilus）分布和耐药性变迁，为临床合理用药提供依据。方法用哥伦比亚巧克力平板培养基分离嗜血杆菌，卫星试验初步鉴定，嗜血杆菌鉴定卡（NH卡）确认鉴定菌株，纸片琼脂扩散法（Kirby～Bauer）做药敏试验并检测β-内酰胺酶。结果2010～2012年共分离出394株嗜血杆菌，其中流感嗜血杆菌126株（31．2％），副流感嗜血杆菌268株（68．8％），嗜血杆菌β-内酰胺酶的产生率为40．8％；流感嗜血杆菌对头孢呋辛钠、环丙沙星、氨苄西林、复方新诺明的耐药率较高并有逐年升高趋势，副流感嗜血杆菌对头孢呋辛钠、环丙沙星、左氧氟沙星、氨苄西林、复方新诺明也有明显的高耐药率和逐年升高的趋势。两种细菌对三代四代头孢菌素、加酶抑制剂青霉素和碳青霉烯类药物的耐药率明显较低。结论呼吸道流感嗜血杆菌的检出率低于副流感嗜血杆菌的检出率，治疗这类细菌的感染可首选三代四代头孢菌素和加酶抑制剂青霉素。临床微生物室应加强对呼吸道嗜血杆菌常规分离培养及药敏试验，为临床医生合理使用抗生素提供依据，降低嗜血杆菌的耐药率。

Haemophilns Isolated from Respiratory Tract Infections and Their Drug Resistance from 2010 to 2012

Objective To investigate the distribution and drug resistance of Haemophilus isolated from respiratory tract in our hospital from 2010 to 2012, and guide the antibiotic practice. Methods Haemophilus was isolated by Colombia chocolate medi- um,preliminarily identified by satellite testing and confirmed by the NH identification card. The disc agar diffusion method（ Kirby-Bauer） was employed for susceptibility testing and detection of 15-1actamase. Results From 2010 to 2012, we isolated 394 Haemophilus, which included 126 （31.2% ） Haemophilus influenzae and 268 （68.8%） Haemophilus parainfluenzae. The production of beta-lactamase of Haemophilus was 40.8%. The resistance rate of Haemophilus influenzae to cefuroxime sodium, ciproflox- acin, ampicillin and cotrimoxazole was very high and increased year by year. The same as Haemopbilus influenzae, the resistance rate of the Haemophilus parainfluenzae to cefuroximesodium, ciprofloxacin, levofloxacin, ampicillin and cotrimoxazole was also markedly high and increased year by year. However, the resistance rates of the two typos of Haemophilus to third and fourth generation cephalosporins, penicillins with beta-lactamase inhibitors drug and carbapenem was significantly low. Conclusion The pos- itive rate of Haemophilus influenzae was lower than that of Haemophilus parainfluenzae. The third and fourth generation cephalo- sporins and penicillins with beta-lactamase inhibitors drug were the first choice in the treatment of infections caused by this type of bacteria. The clinical microbiology room should play more attentions on the conventional isolation, culture and sensitivity testing on Haemophilus isolated from respiratory tract infection, and provides the basis for rational using of antibiotics and thus reduces the resistance of Haemophilus.