某基层医院呼吸道感染者标本嗜血杆菌的分离与耐药情况

目的 了解某基层医院呼吸道感染患者嗜血杆菌的分离率、产酶率及耐药情况，以指导临床合理用药。方法对该院2005年8月-2007年9月收集的712份痰及咽拭子标本进行嗜血杆菌分离培养、鉴定，并以头孢硝噻吩纸片法进行伊内酰胺酶测定，采用K—B纸片扩散法进行药敏试验。结果共分离嗜血杆菌151株，其中流感嗜血杆菌43株（28．48％），副流感嗜血杆菌108株（71．52％）；检出β-内酰胺酶阳性菌株19株（12．58％），其中流感嗜血杆菌中检出6株（13．95％），副流感嗜血杆菌中检出13株（12．04％）。嗜血杆菌对氨苄西林、复方磺胺甲嚼唑、环丙沙星的耐药率分别为30．46％、77．48％、63．58％，对头孢呋辛、头孢噻肟耐药率仅为9．27％、5．96％。19株产酶菌对氨苄西林均耐药。结论该院呼吸道嗜血杆菌感染患者以感染副流感嗜血杆菌为主，临床治疗宜首选第二代与第三代头孢菌素及亚胺培南等药物。

Isolation and antimicrobial resistance of Haemophilus from patients with respiratory tract infection in a basic-level hospital

Objective To investigate the isolation rate, enzyme-producing rate and drug resistance of Haemophilus influenzae in a basic-level hospital, so as to guide the rational use of antimicrobial agents in clinic. Methods Haemophilus from 712 sputum and throat swabs taken from August 2005 to September 2007 were isolated and iden tified, 13 lactamases were detected by nitrocefin, antimicrobial susceptibility tests were performed with Kirby Bauer method. Results One hundred and fifty one strains of Haemophilus were isolated, 43（28.48%） were Haemophilus influenzae, and 108（71.52%） were Haernophilus parainfluenzae; 19 （12. 58%） were β- lactamases positive strains, 6 （13. 95%） of which were Haemophilus influenzae, and 13 （12. 04%） were Haemophilus parainfluenzae. The resistant rate of Haemophilus to ampicillin, trimethoprim /sulfamethoxazole and ciprofloxacin was 30. 46%, 77. 48% and 63.58% respectively, the resistant rate to cefuroxime and cefotaxime was only 9. 27G and 5. 96% respectively, all β-lactamase strains were resistant to ampicillin. Conclusion Haernophilus parainfluenzae is the main pathogen in respiratory tract infection in this hospital, imipenem and the second and third generation cephalosporins are the most effective antimicrobial agents for treating Haemophilus infection.