不同青霉素红霉素敏感性组合模式肺炎链球菌的抗生素敏感性特征  

Characters of antimicrobial resistance for streptococcus pneumoniae categorized according to their susceptibility to penicillin and erythromycin

作　　者：姚开虎[1] 陆权[2] 邓力[3] 俞桑洁[1] 张泓[4] 邓秋莲[5] 沈叙庄[1] 杨永弘[1] 

机构地区：[1]首都医科大学附属北京儿童医院儿科研究所微生物室,北京100045 [2]上海交通大学儿童医院呼吸科,上海200040 [3]广州儿童医院呼吸科,广东广州510120 [4]上海交通大学儿童医院检验科,上海200040 [5]广州儿童医院检验科,广东广州510120

出　　处：《中国实用儿科杂志》2007年第8期583-586,共4页Chinese Journal of Practical Pediatrics

基　　金：国家自然科学基金资助项目(30070793);北京市科技计划项目(Y020400404131);国家"十五"科技攻关项目(2004BA720A09-01)

摘　　要：目的分析不同青霉素和红霉素敏感性组合模式的肺炎链球菌对其他常用抗生素敏感性分布的特征,探讨监测青霉素和红霉素敏感性是否具有代表性意义。方法对2000—2002年每年2～5月北京、上海、广州三家儿童医院门诊就诊(年龄1个月至5岁)的急性上呼吸道感染儿童鼻咽部分离肺炎链球菌,采用纸片扩散法和E-test最小抑菌浓度(MIC)法检测其对8种常用抗生素的敏感性。结果将青霉素敏感性分为R(耐药)、I(中介)和S(敏感),红霉素敏感性分为NS(不敏感)和S(敏感),按青霉素敏感性/红霉素敏感性组合模式可分为6组(没有分离到R/S模式菌株)。R/NS组29·8%(17/57)对头孢曲松不敏感;对头孢呋辛和头孢克洛均不敏感;阿莫西林/克拉维酸不敏感株只出现于R/NS组。I/NS组仅0·03%(8/288)对头孢曲松不敏感;头孢呋辛和头孢克洛不敏感率分别为38·2%(110/288)和52·4%(151/288)。头孢克洛不敏感菌株还出现于I/S组。复方新诺明敏感性主要与红霉素是否敏感有关。氯霉素耐药株在各组分布的差异没有统计学意义。R/NS和I/NS几乎都是联合耐药株,S/S组无联合耐药株。结论不同青霉素和红霉素敏感性组合模式的肺炎链球菌对其他常用抗生素敏感性分布具有各自不同的特点,青霉素和红霉素是肺炎链球菌耐药性监测的代表性药物。Objective To discuss the characters of antimicrobial resistant profiles of Streptococcus pneumoniae with different profiles of penicillin and erythromycin resistance. Methods Nasopharageal swab specimens were collected from randomly selected less than 5-year-old out-patients with upper respiratory infection in Beijing, Shanghai and Guangzhou, 2000 - 2002. Antibiotic susceptibility was determinated by E-test MIC method for erythromycin and β-lactam antibiotics （ penicillin,amoxicillin/clavulanic acid,cefaclor, cefuroxime and ceflriaxone） and by KB disk diffusion method for sulfamethoxazole/trimethoprim and chloramphenicol. Results According to penicillin susceptibility ： resistatant （ R ） , intermediate （ I ）, susceptible （ S ）, and erythromycin susceptibility ： nonsusceptible （ NS ）, susceptible （ S ）, the pneumococcal strains could be divided into 6 groups：R/NS, R/S, I/NS, I/S,S/NS and S/S. There was no strain belonging to R/S pattern. All R/NS strains were resistant to cefaclor and nonsusceptible to cefuroxime, while 29. 8% of them nonsusceptible to cefiriaxone. Amoxicillin/clavulanic acid nonsusceptible strains were only found in R/NS group. Only 0. 03% I/NS strains were nonsusceptible to ceftriaxone, and almost all of which were intermediate level. The nonsusceptible rates of I/NS group for cefuroxime and cefaclor were 38. 2% and 52.4%. A few cefaclor nonsusceptible strains were found in I/S group,too. Thesulfamethoxazole/trimethoprim susceptibility was mainly related to erythromycin susceptibility. The resistant rates for chloramphenicol were similar among the groups （ χ^2 = 7. 77, P 〉 0. 05 ）. No strains which were resistant to two or more kinds of antibiotics were found in S/S group, while most of R/NS and I/NS strains were such strains. Conclusion Different characters of antimicrobial resist- ance are found for different penumococcal strains divided according to susceptibility to penicillin and erythromycin.The two representative drugs,penicillin and erythromyein, mus

关 键 词：肺炎链球菌 抗生素 抗生素耐药性 青霉素 红霉素 

分 类 号：R378[医药卫生—病原生物学]