一所大型教学医院临床分离肺炎链球菌耐药性分析

目的了解一所大型教学医院临床分离的肺炎链球菌临床分布及耐药情况，为临床合理使用抗菌药物，预防和控制感染提供依据。方法收集中南大学湘雅医院2010年11月-2012年11月临床标本分离的肺炎链球菌192株，均经全自动细菌鉴定仪鉴定。采用K B法检测其对常用14种抗菌药物的敏感性，琼脂稀释法检测青霉素的最低抑菌浓度(MIC)。结果肺炎链球菌主要分离自儿科（36.98%），标本主要为痰液（64.07%）；患者年龄呈双峰分布，以＜5岁和＞50岁的感染者较多。肺炎链球菌对红霉素、氯霉素、四环素、克林霉素耐药率均＞80%。192株肺炎链球菌青霉素MIC范围为0.015～≥32.0 μg/mL，其中MIC50为2.0 μg/mL，MIC90为16.0 μg/mL。非侵袭性肺炎链球菌耐药性高于侵袭性肺炎链球菌。结论该院肺炎链球菌耐药情况较为严重，在临床上对肺炎链球菌的治疗应重视青霉素耐药菌株的出现。

Antimicrobial resistance of Streptococcus pneumoniae in a large teaching hospital

Objective To investigate the characteristics of distribution and drug resistance of Streptococcus pneumoniae（S.pneumoniae）in a large teaching hospital,and provide the basis for the rational use of antimicrobial agents in the clinic.Methods 192 clinical isolates of S.pneumoniaefrom Xiangya Hospital between November 2010and November 2012 were identified by Vitek-2 system.Susceptibility of these isolates to 14 kinds of commonly used antimicrobial agents were determined by Kirby-Bauer method,the minimum inhibitory concentration（MIC）of S.pneumoniae to penicillin was determined by agar dilution method.Results S.pneumoniae were mainly from pediatric department（36.98%）,sputum was main specimen（64.07%）;patients＇ age showed bimodal distribution,mainly5 and50 years old.The resistance rates of S.pneumoniae to erythromycin,chloramphenicol,tetracycline,and clindamycin were all80%.MIC range of penicillin to all S.pneumoniae was 0.015- ≥32.0μg/mL,MIC50and MIC90was 2.0μg/mL and 16.0μg/mL respectively.The resistance rates of non-invasive S.pneumoniae was higher than invasive one.Conclusion Antimicrobial resistance of S.pneumoniae in this hospital is serious,the emergence of penicillin-resistant S.pneumoniae should be paid attention during clinical treatment.