2006～2010年武汉同济医院呼吸道苛养菌的耐药性分析

目的了解2006～2010年武汉同济医院呼吸道标本中苛养菌的分离情况及耐药性,为临床合理用药提供依据。方法对2006年～2010年呼吸道标本分离的肺炎链球菌、流感嗜血杆菌以及卡他布兰汉菌,用Kirbry-Bauer法进行药敏试验,E-test法检测肺炎链球菌对青霉素的敏感性。以头孢硝噻吩纸片测定β-内酰胺酶。结果共收集到肺炎链球菌503株,流感嗜血杆菌658株以及卡他布兰汉菌142株。5年总的青霉素不敏感肺炎链球菌(PNSSP)为22.5%(113/503),其中青霉素耐药肺炎链球菌(PRSP)为4.7%。肺炎链球菌对克林霉素及红霉素高度耐药,尤其是儿童分离株敏感性不足10%;但对莫西沙星及左氧氟沙星敏感性良好,达90%以上,未出现耐万古霉素肺炎链球菌。流感嗜血杆菌对复方磺胺甲噁唑的敏感率最低,仅40.6%;对氨苄西林的敏感性也只有60%左右。但对头孢呋新、头孢噻肟、阿奇霉素、环丙沙星和左氧氟沙星的敏感性均在85%以上。卡他布兰汉菌产β-内酰胺酶率高达98.6%。以上苛养菌对各种抗菌药物敏感性均呈逐年下降趋势。结论大多数抗菌药物对呼吸道苛养菌仍然保持较好的抗菌活性,但青霉素类抗菌药物对上述3种细菌不敏感率已超过30%,尤其是卡他布兰汉菌。应加强细菌耐药性监测并根据药敏结果合理选用抗菌药物进行治疗。

Surveillance of Antimicrobial Resistance of Fastidious Bacteria from Respiratory Specimens in Tongji Hospital

Objective To investigate the distribution and the antimicrobial resistance in clinical isolates of fastidious bacteria from Tongji Hospital and to guide antibiotic practice.Methods Clinical isolates of Streptococcus pneumoniae,Haemophilus influenzae,and Branhamaceae catarrhalis were collected from 2006 to 2010.The MIC of penicillin was determined by E-test,and other antimicrobial susceptibility was tested by Kirby-Bauer method.Beta-lactamases were detected by nitrocefin disk.Results 503 Streptococcus pneumoniae,658 Haemophilus influenzae and 142 Branhamaceae catarrhalis were collected.The total rate of PNSSP was 22.5%,among them 4.7% were PRSP.Streptococcus pneumoniae were high resistant to Clindamycin and Erythromycin,especially those isolated from children.But 90% of them were susceptible to Moxifloxacin and Levofloxacin,and no strain was resistant to Vancomycin.Haemophilus influenzae were low susceptible to Trimethoprim-sulfamethoxazole,accounting for 40.6%;and 60% were susceptible to Ampicillin;but about 85% strains were susceptible to Cefuroxime,Cefotaxime,Azithromycin,Ciprofloxacin and Levofloxacin.The prevalence of beta-lactamase was high in Branhamaceae catarrhalis,about 98.6%.The resistance rate of all three bacteria was increased to varying degrees year by year.Conclusion The isolates were sensitive to the majority of antibiotics,but more than 30% strains were non-susceptible to Penicillin,especially Branhamaceae catarrhalis.It was suggested that antibiotics should be chosen according to antimicrobial susceptibility test results.