肺炎链球菌的耐药性及其血清型分布调查

目的 了解中山市肺炎链球菌的耐药性及其血清型分布情况，比较正常人群肺炎链球携带株与临床分离株的耐药性与血清型分布关系，探讨肺炎链球菌的耐药性和血清型分布特点。方法 肺炎链球菌的培养、分离和鉴定按《全国临床检验操作规程》进行；药敏试验根据美国临床实验室标准委员会(NCCLS)有关抗生素敏感性试验法规进行试验并对结果进行判定；肺炎链球菌分型使用Quellung反应方法。结果 266株肺炎链球菌中耐青霉素肺炎链球菌占26．7％；耐青霉素肺炎链球菌对红霉素、四环素、氯霉素、克林霉素、利福平和复方新诺明的耐药率高达97．1％、100％、56．3％、84．5％、42．5％、78．9％；在所有菌株中排在前9位(占所有血清型的65．9％)的常见血清型是23F(13．2％)、6A(12．4％)、19F、(10．9％)、6B(7．1％)、14(6．4％)、1．5B(5．3％)、NT(5．3％)、19A(3．0％)、22F(2．3％)。而71株对青霉素不敏感的菌株中排在前9位的常见血清型分别为19F、23F、14型、不能分型、6B、22F、、9V、19B和33F。目前推荐使用的23价肺炎球菌多糖疫苗(1，2，3，4，5，6B，7F，8，9N，9V，10A，11A，12F，14，15B，17F，18C，19A，19F，20，22F，23F，33F、)能覆盖所有分离菌株血清型71．9％。结论 在携带者中，肺炎链球菌对青霉素耐药率已处于较高水平，耐青霉素肺炎链球菌同时对其它常用抗生素普遍耐药，且已发现对三代头孢菌素耐药菌株，对红霉素、四环素、氯霉素、克林霉素材复方新诺明耐药已非常严重；建议对小儿和体弱老人使用23价肺炎球菌多糖疫苗预防接种以减少抗生素的使用和降低耐药菌株出现的压力。

Resistance and Serotype of Streptococcus Pneumoniae in Zhongshan City

Objective This study is designed to investigate bacterial resistance and the prevalence of serotype of Streptococcus pneumoniae. Methods Sensitivity to penicillin, cefotaxime, erythromycin, tetracycline, chloramphenicol, clindamycin, ofloxacin, Rifampin, vancomycin and trimethoprim-sulfamiethoxazole was determined by K-B and E-test methods according to NCCLS. Serotyping of the Streptococcus Pneumoniae strains was performed by using Quelling Reaction. Result Resistance of 266 species Streptococcus Pneumoniae were as follows: Penicillin, 26.7 %(22.9% intermediate; 3.8% resistant); erythromycin, 65.4%; tetracycline, 51.7%; chloramphenicol, 45.8%; clindamycin, 53.0%; cefotaxime, 5.0%; Rifampin, 36.5%; ofloxacin, 1.5%; vancomycin, 0% and trimethoprim-sulfamiethoxazole, 66.5%. Serotype 23 F ( 13.2% ),6 A (12.4%),19 F (10.9%),6 B (7.1%),14 (6.4%),15 B (5.3%),NT(5.3%),19 A (3.0%),22 F (2.3%) were most common. Conclusion These data show that carriage of antibiotic-resistant pneumococcal is high in Zhongshan city. Erythromycin, Tetracycline, Chloramphenicol, Clindamycin and Trimethoprim-sulfamiethoxazole resistance was very common. All strains were susceptible to Vancomycin. This study showed that Pneumococcal Vaccine Polyvalent did cover the majority of strains isolated.