2004—2009年濮阳市儿童肺炎链球菌、流感嗜血杆菌耐药性调查

目的调查濮阳市近6年从儿科临床标本中分离的肺炎链球菌、流感嗜血杆菌的耐药性状况及本地流感嗜血杆菌流行的生物型。方法用API—NH和Vitek2compact对菌株进行鉴定。依据API—NH条中的鸟氨酸脱羧酶、脲酶及吲哚试验将流感嗜血杆菌分为不同的生物型。用微量肉汤稀释法分别测定其最低抑菌浓度。结果青霉素敏感肺炎链球菌（PSSP）与青霉素不敏感肺炎链球菌（PNSP）分别占48．9％、51．1％。肺炎链球菌对阿莫西林、阿莫西林／克拉维酸、头孢曲松、头孢呋辛、左氧氟沙星、万古霉素、克林霉素、红霉素的敏感率分别为75．0％、92．0％、93．6％、84．0％、100．0％、100．0％、34．1％、8．5％。40．5％的流感嗜血杆菌产β-内酰胺酶。流感嗜血杆菌生物分型以Ⅰ型、Ⅱ型、Ⅲ型为主，占85．9％。流感嗜血杆菌对氨苄西林、阿莫西林／克拉维酸、头孢曲松、头孢呋辛、左氧氟沙星、阿齐霉素的敏感率分别为73．0％、100．0％、100．0％、96．3％、100．0％、93．3％。结论本地区儿童肺炎链球菌耐药形势严峻。阿莫西林／克拉维酸、头孢曲松、头孢呋辛是治疗儿童肺炎链球菌、流感嗜血杆菌是最有活性的抗菌药物，此外，阿齐霉素对感嗜血杆菌也有很高的敏感性。

An investigation of antimicrobial resistance of Streptococcus pneumoniae and Hemophilus influenzae isolated from children in Puyang between 2004 and 2009

Objective To investigate the situation of resistance of S. pneumoniae, H. influenzae isolated from clinical samples of department of pediatrics in recent six years in Puyang city and the prevalent biotype of H. influenzae in our region. Methods Identification of bacteria was conducted with API - NH strip and Vitek 2 compact. H. influcnzae is classified into distinct biotypes on the basis of ornithine decarboxylase, urease, and indole activities of API -NH strip. The minimal inhibitory concentrations were measured by broth microdilution method. Results Penicillin - susceptible and non - penicillin - susceptible S. pneumoniae were 48.9% and 51.1%, respectively. The sensitive rates of S. pneumoniae to amoxicillin, amoxicillin/clavulanic acid, cefiriaxone, cefuroxime, levofloxacin, vancomycin, clindamycin, erythromycin were 75.0%, 92.0%, 93.6%, 84.0%, 100.0%, 100. 0%, 34. 1% and 8.5%, respectively. The rate of producing β- lactamases of H. influenzae was 40.5%. Biotype I, II and III were predominant（85.9% ）. The sensitive rates of H. influenzae to ampicillin, amoxicillin/clavulanic acid, ceftriaxone, cefuroxime, levofloxacin and azithromycin were 73.0% , 100.0% , 100.0% , 96.3%, 100.0% and 93.3% , respectively. Conclusions The resistant of S. pneumoniae isolated from children in the area had become a severe problem. Amoxicillin/clavulanic acid, cefiriaxone, cefuroxime were the most active antibacterials against S. pneumoniae and H. influenzae. H. influenzae was highly susceptible to the azithromycin.