2000～2004年京沪穗渝5家儿童医院革兰阳性球菌耐药情况分析  

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

作　　者：汪玲[1] 陆权[2] 王传清[3] 邓秋莲[4] 刘岚[5] 甄景慧[1] 张泓[2] 王艺[3] 黄勇[4] 陈沅[5] 杨永弘[1] 沈叙庄[1] 

机构地区：[1]首都医科大学附属北京儿童医院,北京100045 [2]上海交通大学附属上海儿童医院,上海200040 [3]复旦大学附属儿科医院,上海200032 [4]广州市儿童医院,广州510120 [5]重庆医科大学附属儿童医院,重庆400014

出　　处：《中国循证儿科杂志》2006年第2期113-121,共9页Chinese Journal of Evidence Based Pediatrics

基　　金：国家科技部十五攻关项目资助(2004BA720A09-01)

摘　　要：目的分析2000～2004年北京、上海、广州和重庆儿科主要革兰阳性球菌耐药的情况。方法对北京、上海、广州和重庆地区的5家儿童专科医院检验科送检标本分离出的4种革兰阳性球菌(共计8215株)进行Kirby-Bauer琼脂扩散法抗生素敏感实验,按照2000～2004年每年美国临床实验室标准化委员会标准进行判读,并计算出所测细菌抗生素的耐药率(R％+I％)和敏感率(S％)。结果从感染患儿中分离出金黄色葡萄球菌共4004株,耐甲氧西林的金黄色葡萄球菌(NRSA)检出率为7．15％,对红霉素总耐药率为61．96％,未发现耐万古霉素的金黄色葡萄球菌(VRSA)或万古毒素中度敏感金黄色葡萄球菌(VISA);肺炎链球菌共2402株,对青霉素不敏感肺炎链球菌(PNSP)的检出率为63．42％．对红霉素总耐药率为86．22％;β溶血性链球菌共432株,均对青霉素敏感,对红霉素的耐药率为68．47％,且耐药率呈上升趋势。肠球菌共1377株,对氨苄西林的总耐药率为51．91％,对红霉素的总耐药率高达88．10％。结论除β溶血性链球菌之外的革兰阳性球菌对广谱青霉素的耐药率都偏高;对红霉素的耐药率居高不下,并有逐年上升的趋势;革兰阳性球菌对万古霉素和环丙沙星的敏感率较高。MRSA仍在较低水平,在本研究中未发现VRSA和VISA,但是出现了对万古霉素耐药的肠球菌,耐药形势不容乐观,因此仍需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。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 1^st 2000 to Dee 31^st 2004, a total of four types pathogenic strains was isolated from 5 pediatric hospitals which were Beijing Childreng Hospital, Childreng Hospital of Fudan University, Shanghai Childreng Hospital, Guangzhou Childreng 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 , Erythremycin, 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

关 键 词：革兰阳性球菌 金黄色葡萄球菌 肺炎链球菌 Β溶血性链球菌 肠球菌 儿科 耐药 

分 类 号：R446.5[医药卫生—诊断学]