广州地区肺炎住院患儿感染肺炎链球菌的血清型分布及耐药性研究

目的了解广州地区肺炎住院的患儿感染肺炎链球菌的耐药性及血清型分布情况。方法用吸痰法采集患儿痰标本进行涂片，革兰氏染色镜检，合格痰标本划线接种血平板，用E-test法检测分离到的肺炎链球菌对青霉素、阿莫西林、头孢曲松、头孢呋辛、亚胺培南、氧氟沙星、万古霉素、红霉素和克林霉素9种药物的耐药性，采用K-B法检测四环素、复方新诺明的耐药性，并采用荚膜肿胀技术对分离到的79株肺炎链球菌进行血清分型。结果79株肺炎链球菌中青霉素耐药肺炎链球菌（PRSP）11．4％，青霉素中介肺炎链球菌（PISP）77．2％，青霉素敏感肺炎链球菌（PSSP）11．4％，对红霉素、克林霉素的耐药率分别为100％和93．7％，对阿莫西林、氧氟沙星、万古霉素的耐药率均为0，对头孢曲松、头孢呋辛、亚胺培南的耐药率分别为3．8％、72．2％、2．5％。79株肺炎链球菌中只有1株PSSP仅对红霉素耐药．78株肺炎链球菌对两种以上药物耐药．多重耐药率为98．7％（78／79），同时对克林霉素、红霉素、四环素、复方新诺明耐药的菌株65株，占82．3％（65／79）。79株肺炎链球菌血清型分别为19F（70．9％），23F（16．5％），6B（5．1％），4（2．5％），15B（2．5％），不能分型（2．5％），7价疫苗涵盖率为94．9％（75／79）。结论广州地区肺炎住院患儿肺炎链球菌对大环内脂类抗生素红霉素和林可酰胺类抗生素克林霉素耐药情况严重，对二代头孢菌素头孢呋辛耐药率居高，临床治疗儿童肺炎链球菌感染的肺炎应首选阿莫西林和三代头孢菌素。7价疫苗覆盖率高。预防儿童肺炎链球菌感染所致的肺炎，采用7价疫苗可以达到很好效果。

Serotype Distribution and Antibiotic Resistance of Streptococcus pneumoniae Isolated from Children in Guangzhou

Objective The present study was designed to investigate the distribution of serotypes and antibiotics resistance of Streptococcus pneumoniae isolated from in-patient children with pneumonia in children hospitals in Guangzbou. Methods Sputum specimens were randomly collected from in-patient children of less than 6-year-old with pneumonia. Antibiotic susceptibility test was used to test for these clinical isolates. Quellung method was used for serotyping. Results Among 79 strains of Streptococcous pneumoniae, the rate of penicillin resistance Sp（PRSP） was 11.4%. The rate of drug resistance of Streptococcous pneumoniae to ofloxaein, vancomycin and amoxicillin were 0. The rate of drug resistance of Streptococcous pneumoniae to eeftriaxone, cefuroxime, imipenem, erythromycin and clindamycin was 3.8%, 72.2%, 2.5%, 100% and 93.5%, respectively. The rate of muhi-drug resistance was high （98.7%）. 79 strains were classified as the serotype 19F （70.9%）, 23F （16.5%）, 6B （5.1%）, 15B （2.5%）, 4 （2.5%） and NT （2.5%）. Coverage rate of the heptavalent vaccines was 94.9%. Conclusion The resistance of Streptococcous pneumoniae to erythromycin and Clindamycin was high. The isolation rate of penicillin resistant Streptococcous pneumoniae was low among children in Guangzhou, and the PISP rate was increased. The heptavalent conjugate vaccine is effective in controlling the infection and transmission of Streptococcous pneumoniae.