2000~2004京沪穗渝5家儿童医院革兰阳性球菌耐药情况分析

摘要]探讨我国不同地区儿科主要革兰阳性球菌耐药的情况。方法 对五家儿童专科医院从2000年1月1日至2004年12月31日内检验科送检标本分离出的四种革兰阳性球菌(共计8215株)进行Kirby-Bauer琼脂扩散法进行抗生素敏感试验，并按照每年NCCLS标准进行判读，并计算出所测细菌对抗菌药物的耐药率（R%＋I%）和敏感率（S%）。 结果 从感染患儿中分离出4004株金黄色葡萄球菌，甲氧西林耐药金黄色葡萄球菌（MRSA）的检出率为7.15%，红霉素总耐药率为61.96%,并且有逐年上升的趋势，4004株金葡菌中未发现对万古霉素耐药或中介的金葡菌；肺炎链球菌共2402株，青霉素不敏感肺炎链球菌（PNSP）的检出率为63.42%，红霉素耐药率为86.22%，两者耐药率均在上升；β溶血性链球菌共432株，对青霉素全部敏感，对红霉素的耐药率为68.47%，且耐药率在逐年增加；肠球菌共1377株，对万古霉素的中度敏感率为2.73%，对氨苄西林的耐药率为51.91%，对红霉素的耐药率高达88.10%。 结论 除了β溶血性链球菌之外，多数G＋细菌对广谱青霉素的耐药率都偏高；G＋细菌对万古霉素和环丙沙星的敏感率较高,但对红霉素的耐药率居高不下并有逐年上升的趋势。MRSA及仍在较低水平，在本研究中没有发现VRSA及VISA，但是仍然要加强各地对革兰阳性球菌耐药性和抗生素使用情况的监测,合理使用抗生素。

Susceptibility of Gram-positive bacteria to antimicrobial drugs among pediatric patients in China: an analysis of hospital data from Beijing, Shanghai, Guangzhou and Chongqing 2000-2004

Objective To investigate the drug-resistance rate of gram-positive cocci isolated from petients in 5 pediatric hospitals located in different areas in China. Methods From Jan 1st 2000 to Dec 31st 2004,a total of four types pathogenic strains was isolated from 5 pediatric hospitals which were Beijing Children's Hospital, Children's Hospital of Fudan University, Shanghai Children's Hospital, Guangzhou Children's Hospital and Chongqing Children's Hospital. 8215 isolates were from hospital acquired infection( HAI) and community acquired infection (CAI). The all 8215 strains were tested by Kirby-Bauer method. According to the criteria of guidelines of NCCLS in each year from 2000 to 2004, the persentage of resistance as the resistance and intermediate, and the percentage of susceptabilily rate of bacteria to the compound tested. We chose Penicillin, Oxacillin, Amoxicillin and Clavulanat, Clindamycin, Cefuroxime , Ceftriaxone , Erythromycin, Compound Sulfamethoxazole and Vancomycin to test Streptococcus aureus; Penicillin, Erythromycin , Clindamycin, Vancomycin, Ofloxacin and Compound Sulfamethoxazole test Streptococcus pneumoniae; Penicillin, Erythromycin, Clindamycin, Vancomycin and Ofloxacin to test Streptococci hemolyticus; Ampicillin, Streptomycin ( high concentration) , Gentamycin ( high concentration, Ciprofloxacin, Vancomycin, Teicoplanin, Erythromycin and Rifampicin to test Enterococcus. Results Among a total of 4004 strains of Streptococcus aureus, the detectable rates of methicilin-resistantce in Staphylococcus aureus(MRSA) was 7. 15% , the rate of resistance to erythromycin was increased to 61. 96%. The rate of MRSA from two the hospitals in Shanghai was higher than the others. All Streptococcus aureus isolates were susceptible to vancomycin. 2 402 strains of S. pneumoniae were isolated. The rate of penicillin unsusceptible Streptococcus pneumoniae (PRSP) was 63.42% , and the rate of resistance to erythromycin was 86. 22% ; The total strains of 432 streptococci hemolyticus were all susceptible to penicillin, while the rate of resistance to erythromycin was 68. 47% which was rising year by year. The rate of erythromycin- resistant were various from 37.73% to 100% by area; 2. 73% from all 1377 isolated Enterococcus strains was found intermediate to vancomycin,and the rate of ampicillin resistant was 51.91%. We found that all the vancomycin-intermediate Enterococcus were from Shanghai. The rate of resistance to erythromycin was 88. 10%. Conclusions Except streptococci hemolyticus, G coccus showed a high resistant rate to penicillin; almost all G coccus were susceptible to vancomycin and teicomycin, and resistant to erythromycin with a trend of rising. MRSA was low in rate,and we havent find VRSA and VISA. There was 2.73% of Enterococcus intermediate to vancomycin and more attention should be payed to it. Antimicrobial resistant coccus in pediatric has already become a serious problem in China. Ongoing surveillance for antimicrobial resistance of gram-positive coccus is necessary for the appropriate antimicrobial use in pediatric clinical practice.