儿童肺炎链球菌的血清型及对抗生素的耐药性

目的　对本校儿科医院住院病例进行肺炎链球菌的血清型和耐药性监测。方法　收集因呼吸道感染而住院的病例痰标本和病史资料 ,同时采集部分患儿的血标本 ,分离与鉴定标本中的肺炎链球菌。荚膜肿胀试验进行血清分型 ;E test测定对青霉素的最低抑菌浓度。结果　共收集到 10 13例患儿的资料 ,分离出 112株肺炎链球菌。 19F、2 3F、6A、14和 6B等 5种血清型占 81.3% ( 91/112 ) ,其他类型的血清型占 11.6 % ( 13/112 )。另有 7.1% ( 8/112 )的肺炎链球菌不能分型。只有 1例血标本检测到肺炎链球菌 ,这可能与患儿入院前的抗菌素广泛使用有关。对青霉素中度和高度耐药的肺炎链球菌比例分别为 5 0 .9%和 8.0 % ;对氨苄青霉素、头孢唑林、头孢克洛、头孢曲松、红霉素、氯林可霉素和氯霉素的耐药率分别为 5 8.6 %、6 .6 %、2 5 .0 %、6 .6 %、85 .7%、6 6 .7%和 2 8.2 %。在 6 6例对青霉素耐药的菌株中 ,以 9F血清型最为多见 ,其次为 2 3F和 14。结论　肺炎链球菌是导致上海地区儿童呼吸道感染的重要病原菌 ,主要由 5种血清型组成 ,该菌株对各类抗菌素的耐药性普遍较高

Serotype Distribution and Antimicrobial Resistance Patterns in Streptococcus Pneumoniae Isolates from Hospitalized Pediatric Patients with Respiratory Infections in Shanghai,China

Purpose To conduct surveillance for pneumococcal respiratory illness in children hospitalized at Affiliated Pediatric Hospital of Fudan University in Shanghai from August 2000 to August 2001. Methods Sputum cultures were obtained from pediatric patients admitted with pneumonia or respiratory distress by tracheal aspirate.Blood cultures were also performed on a subset of patients.Isolates were identified as S.pneumoniae by typical colony morphology,alphahemolysis and Gram staining.Confirmatory tests included Optochin susceptibility and bile solubility tests.All pneumococcal isolates were serotyped and tested for antibiotic susceptibility.In addition,clinical information on the patients including prior antibiotic history was abstracted. Results Streptococcus pneumoniae tracheal isolations were attempted in a total of 1 013 pedi atric patients hospitalized during this period.Among these samples, 112 specimens were Streptococcus pneumoniae positive.These positive isolates underwent serotyping and antibiotic susceptibility testing.Five serotypes (19F,23F,6A,14,6B) of Streptococcus pneumonia accounted for 81.3%(91 of 112 cases). Other serotypes accounted only for 11.6%(13 of 112 cases) and 7.1% (8 of 112 cases) of isolates could not be typed by Quelling Test.Only one blood culture isolate was positive probably reflecting the high level of antibiotic treatment prior to hospitalization.Fifty one percent and 8.0% of isolates had intermediate levels and high levels of resistance to penicillin respectively.Fifty eight percent were resistant to ampicillin,6.6% to cefazolin,25.0% to cefaclor,6.6% to ceftriaxone,85.7% to erythromycin,66.7% to clindamycin and 28.2% to chloraphenicol.Among 66 isolates that were not susceptible to penicillin,serotype 19F was the most common, followed by 23F and 14. Conclusions Streptococcus pneumoniae is a common cause of respiratory hospitalization in young children in Shanghai,with antibiotic resistance increasingly common.Five serotypes account for most disease.