上呼吸道感染儿童鼻咽部携带肺炎链球菌状况及血清型和耐药性研究

目的 了解上呼吸道感染儿童鼻咽部携带肺炎链球菌状况，以及分离株的耐药性和血清型分布。方法 2013 年3 月至2014 年2 月采集在北京儿童医院门诊就诊的上呼吸道感染儿童鼻咽拭子进行细菌培养和鉴定，采用Etest 方法检测抗生素敏感性，荚膜肿胀试验检测血清型。结果 共采集到2 941 例1 月龄至16 岁患儿的鼻咽拭子，分离出肺炎链球菌699 株，携带率为23.8%。随机选取100 株菌检测了抗生素敏感性和血清型。分离株对静脉青霉素敏感率达98.0%，口服青霉素敏感率仅为33.0%，头孢克洛耐药率为54.0%，头孢曲松和亚胺培南中介率也分别达到18.0% 和38.0%。红霉素和阿奇霉素不敏感率均为97.0%。多重耐药率为86.0%。常见血清型为6A（12.0%）、19F（12.0%）、6B（10.0%）、23F（9.0%）和14 型（8.0%），7、10 和13 价结合疫苗覆盖率分别为41.0%、42.0% 和59.0%。结论 门诊上呼吸道感染儿童中，鼻咽部肺炎链球菌携带率约为25%，抗生素耐药分离株常见，13 价结合疫苗覆盖率接近60.0%。

Nasopharyngeal carriage rate, antimicrobial resistance and serotype distribution of Streptococcus pneumoniae among children with upper respiratory infection

Objective To investigate nasopharyngeal carriage rate, antimicrobial resistance and serotype distribution of Streptococcus pneumoniae among children with upper respiratory infection. Methods Nasopharygeal swabs were collected from children with upper respiratory infection visiting the outpatient department of Beijing Children''s Hospital between March 2013 and February 2014. The antibiotic susceptibility was tested by Etest method, and the serotype was determined by Quellung reaction. Results The nasopharyngeal carriage rate for Streptococcus pneumoniae was 23.8% (699/2 941). One hundred isolates were randomly chosen for antimicrobial susceptiblity test and serotyping. Up to 98.0% isolates were susceptible to parenteral penicillin. The susceptible rate against oral penicillin, however, was 33.0%. The non-susceptible rate to erythromycin and azithromycin was 97.0%. The multi-drug resistance rate was up to 86.0%. The common serotypes were 6A(12.0%), 19F(12.0%), 6B(10.0%), 23F(9.0%) and 14(8.0%). The coverage rates of 7-, 10- and 13-valent pneumococcal conjugate vaccine were 41.0%, 42.0% and 59.0% respectively. Conclusions About 25% of children with upper respiratory infection are nasopharyngeal colonized by Streptococcus pneumoniae. The isolates show a high antimicrobial resistance. The 13-valent pneumococcal conjugate vaccine covers about 60.0% of the isolates.