呼吸道苛养菌对头孢妥仑匹酯等10种抗菌药物的药敏监测

目的了解呼吸道感染苛养菌的分离及其对头孢妥仑匹酯等10种抗菌药物的药敏情况，为临床治疗提供参考。方法收集2005年、2007年、2008年及2010年1-6月从呼吸道细菌感染患者送检的痰标本中分离的苛养菌，采用美国临床实验室标准化研究所推荐的K B法检测头孢妥仑匹酯等10种抗菌药物对其的体外抗菌活性。结果438例患者共分离苛养菌462株，其产β 内酰胺酶率：流感嗜血杆菌23.62%（30/127），副流感嗜血杆菌2.51%（5/199），卡他莫拉菌41.58%（42/101），未发现对青霉素中介或耐药的肺炎链球菌。流感嗜血杆菌、副流感嗜血杆菌、卡他莫拉菌及肺炎链球菌对头孢妥仑匹酯的敏感率分别为96.30%、94.36%、100.00%、100.00%；流感嗜血杆菌和副流感嗜血杆菌对头孢噻肟、头孢呋辛、头孢克罗、头孢唑林的敏感率为83.59%～93.33%，对阿莫西林/克拉维酸的敏感率分别为91.67%、88.21%；卡他莫拉菌、肺炎链球菌对阿莫西林/克拉维酸的敏感率为100.00%；对克拉霉素的敏感率，流感嗜血杆菌为87.96%，其他3种菌为34.29%～59.00%；4种苛养菌对四环素的敏感率较低，为22.86%～63.00%；流感嗜血杆菌、副流感嗜血杆菌、卡他莫拉菌对复方磺胺甲口恶唑的耐药率高，达54.63%～73.33%。结论头孢妥仑匹酯对呼吸道感染的苛养菌具有很强的抗菌活性；临床医生应根据药敏试验结果合理使用抗菌药物，以减少耐药菌的产生。

Susceptibility of cefditoren pivoxil and other nine antimicrobial agents against fastidious bacteria isolated from respiratory tract

Objective To realize the isolation status of fastidious bacteria causing respiratory tract infection and antimicrobial susceptibility of fastidious bacteria to cefditoren pivoxil as well as the other 9 antimicrobial agents, so as to provide reference for clinical treatment. Methods Fastidious bacteria isolated from sputum of patients with respiratory tract infection during the year of 2005, 2007, 2008, and January-June in 2010 were collected. Antimicrobial susceptibility of fastidious bacteria were tested with Kirby-Bauer method recommended by Clinical and Laboratory Standards Institute （CLSI）. Results A total of 462 isolates were isolated from 438 patients, 13 lactamase-producing rate was as follows： Haemophilus influenzae （HI） 23.62% （30/127）, Haemophilus parainfluenzae （HP） 2.51%（5/199）, Moraxella catarrhalis （MC） 41. 58% （42/1/11）, penicillin-resistant Streptococcus pneumoniae （SP） isolates was not found. The susceptibility rate （SR） of HI, HP, MC, and SP to cefditoren pivoxil was 96. 30~, 94. 36%, 100. 00%, and 100. 00%, respectively;The SR of HI and HP to cefotaxime, cefuroxime, eefaclor and cefazolin was 83.59% - 93. 33%, SR to amoxicillin/clavulanic acid was 91.67% and 88.21% respectively; SR of MC and SP to amoxicillin / clavulanic acid was 100. 01/%; SR of HI to elarithromyein was 87. 96%, SR of HP, SP and MC to clarithromycin was 34. 29% - 59. 00%; SR of 4 kinds of fastidious bacteria to tetracycline was 22.86G- 63. 005; The resistant rate of HI, HP and MC to trimethoprim/sulfamethoxazole was 54. 63%- 3.33%. Conclusion Cefditoren pivoxil has strong activity against fastidious bacteria causing respiratory tract infection; in order to reduce the emergence of drug resistant strain, clinicians should choose antimicrobial agents according to antimicrobial susceptibility test results.