2007中国CHINET流感嗜血杆菌耐药性监测  

CHINET 2007 surveillance of antimicrobial resistance in Haemophilus influenzae in China

作　　者：张泓[1] 李万华[1] 王传清[2] 薛建昌[2] 孙自镛[3] 简翠[3] 胡云健[4] 艾效曼[4] 徐英春[5] 孙宏莉[5] 魏莲花[6] 吴玲[6] 卓超[7] 苏丹虹[7] 俞云松[8] 杨青[8] 胡付品[9] 朱德妹[9] 

机构地区：[1]上海交通大学附属儿童医院,上海200040 [2]复旦大学附属儿科医院 [3]华中科技大学同济医学院附属同济医院 [4]卫生部北京医院 [5]中国医学科学院,中国协和医科大学附属协和医院 [6]甘肃省人民医院 [7]广州医学院附属第一医院 [8]浙江大学医学院附属第一医院 [9]复旦大学附属华山医院抗生素研究所

出　　处：《中国感染与化疗杂志》2009年第3期207-209,共3页Chinese Journal of Infection and Chemotherapy

摘　　要：目的了解我国不同地区流感嗜血杆菌临床分离株耐药性。方法全国7所综合性医院和2所儿童医院临床分离的流感嗜血杆菌,用Kirbry-Bauer法作药敏试验,按CLSI2007版判断结果,以Nitrocefin试剂测定β内酰胺酶。结果共收集临床分离流感嗜血杆菌755株,复方磺胺甲口恶唑的耐药率最高,达59.4%,氨苄西林30.1%,氯霉素16.9%。氨苄西林-舒巴坦、环丙沙星、头孢噻肟、阿莫西林-克拉唯酸、阿奇霉素和头孢呋辛的耐药率为10%或以下。儿童分离株对氨苄西林的耐药率(37.4%)高于成人株(13.7%);对环丙沙星的耐药率(1.6%)低于成人株(19.1%)。β内酰胺酶检出率27.4%,其中儿童分离株产酶检出率(34.9%)高于成人分离株产酶检出率(10.6%)。对氨苄西林、复方磺胺甲口恶唑、氯霉素3种及3种以上药物耐药的菌株占26.1%(159/609)。结论大多数抗菌药物对流感嗜血杆菌仍保持良好的抗菌活性,但该菌对过去常用的氨苄西林、复方磺胺甲口恶唑的耐药率在增加,复方磺胺甲口恶唑已不宜用于流感嗜血杆菌引起感染的经验治疗;儿童分离株对氨苄西林的耐药率和产酶检出率均显著高于成人(P<0.05);产β内酰胺酶是流感嗜血杆菌对氨苄西林耐药的主要耐药机制,多重耐药现象应引起重视。Objective To investigate the antibiotic resistance in clinical isolates of Haemophilus influenzae （HI） in China during 2007. Methods Clinical isolates of HI were collected from 9 hospitals in China. Antimicrobial susceptibility was tested by Kirby-Bauer method. Results were analyzed according to CLSI 2007. Beta-lactamases were detected by nitrocefin disk test. Results A total of 755 clinical isolates of HI were collected. About 59.4%, 30.1% and 16.9% of the 755 strains were resistant to trimethoprim-sulfamethoxazole, ampicillin, and chloramphenicol, respectively. No more than 10% of these strains were resistant to ampicillin-sulbactam, ciprofloxacin, ceftazidime, amoxicillin-clavulanic acid, azithromycin, or cefuroxime. About 37.4% of the strains were resistant to ampicillin. Beta-lactamase was produced in 34.9% of the isolates from children. Beta-lactamasepositive strains were more resistant than the isolates from adults （13.7% and 10.6%）. Only 1.6% of the isolates from children were resistant to ciprofloxacin, apparently lower than the isolates from adults （19.1%）. The overall prevalence of β-1actamase was 27. 4%. The prevalence of multidrug-resistant strains was 25.3 % （159/609）, Conclusions The resistance of HI to ampicillin and trimethoprim-sulfamethoxazole is increasing. Trimethoprim-sulfamethoxazole should not be used as empirical treatment of HI infection. The resistance rate to ampicillin and prevalence of β-lactamase are higher in children＇s isolates than in the isolates from adults （P〈 0.05）. The primary mechanism of antibiotic resistance in HI is production of beta-lactamases. More attention should be paid to the multidrug-resistant HI isolated from children.

关 键 词：流感嗜血杆菌 耐药表型 耐药机制 

分 类 号：R446.5[医药卫生—诊断学]