北京地区儿童脓疱疮来源金黄色葡萄球菌耐药性分析

目的分析儿童脓疱疮来源的金黄色葡萄球菌(简称金葡菌)耐药趋势,为治疗儿童脓疱疮提供理论依据。方法对2003年6月-2007年12月就诊于本科门诊的脓疱疮患儿皮损分泌物分离的金葡菌,应用琼脂稀释法药敏试验检测14种抗生素对分离的金葡菌的耐药率,应用WHONET 5.3软件对药敏结果进行分析。结果 984株金葡菌对14种抗生素的药敏试验结果显示,耐药率前3位依次为青霉素、红霉素和克林霉素,其中金葡菌对青霉素的耐药率连续5 a均超过92.0%,对红霉素耐药率均高于80.0%,明显高于其他药物。氯霉素、庆大霉素和四环素耐药率相对稳定,未见明显增减。甲氧西林、头孢菌素和环丙沙星的耐药率相对较低,未超过5.0%;耐甲氧西林金葡菌的发生率低于2%,仅发现1株莫匹罗星耐药菌株,未发现万古霉素和夫西地酸耐药菌株。结论北京地区儿童脓疱疮来源的社区获得性耐甲氧西林金葡菌分离率较低。青霉素、红霉素、克林霉素和四环素等药物在本地区已不适于治疗金葡菌感染的脓疱疮。虽然金葡菌对氯霉素、庆大霉素和环丙沙星敏感性较好,但是鉴于这3类抗生素的不良反应对儿童的影响,应用时应严格掌握其临床适应证。莫匹罗星、夫西地酸、万古霉素和头孢菌素可作为治疗脓疱疮的局部或全身首选用药。

Analysis of Drug Resistance to Staphylococcus Aureus Isolated from Impetigo of Children in Beijing Area

Objective To analyze the drug resistance to staphylococcus aureus(S.aureus) isolated from impetigo in children,in order to find out appropriate agents to treat impetigo. Methods S.aureus which was isolated from clinical specimen from Jun.2003 to Dec.2007 was studied.Susceptibility to 14 antimicrobials was detected using Agar Dilution and all the results were analyzed by the software WHONET 5.3. Results The susceptibility of the 984 S.aureus to 14 antimicrobials showed that the largest number of strains was resistant to penicillin(for 5 consecutive years>92.0%),followed by erythromycin(for 5 consecutive years>80.0%) and clindamycin and tetracycline.Chloramphenicol,gentamicin and tetracycline were at a steady rate.Oxacillin,cephalosporin and ciprofloxacin had shown excellent activity against most S.aureus.The incidence of methicillin-resistant S.aureus was always below 2%.Only 1 strain resistant to mupirocin was found.None of the S.aureus strains were resistant to vancomycin,ceftriaxone and fusidic acid. Conclusions The incidence of community acquired methicillin-resistant S.aureus isolated from impetigo is always lower in Beijing area.Penicillin,erythromycin,clindamycin and tetracycline are no longer appropriate for treating impetigo in children in Beijing area.Chloromycin,gentamycin and ciprofloxacin showed high susceptibility in vitro,but the clinical indications of these drugs must be considered carefully.The effective antibiotic agents for patients with impetigo are cephalosporin,mupirocin,fusidic acid or vancomycin.