2006—2009年重庆地区儿童急性下呼吸道感染流感嗜血菌耐药性监测  

Surveillance of drug resistance against Haemophilus influenzae isolated from children with ALRIs during 2006～2009 year in Chongqing

作　　者：夏勇武[1] 刘岚[1] 王偲[1] 谢伟[1] 印丹[1] 楚丽娟[1] 朱军[1] 刘昌林[1] 景春梅[1] 石宇[1] 

机构地区：[1]重庆医科大学附属儿童医院临检中心,重庆400014

出　　处：《中国抗生素杂志》2011年第3期233-239,I0007,共8页Chinese Journal of Antibiotics

基　　金：重庆市卫生局科教资助项目(渝卫科教[2008]45号2008-2-151)

摘　　要：目的为了解目前流感嗜血菌（Haemophilus influenzae，Hi）引起重庆儿童急性下呼吸道感染的状况及对常用抗菌药物的耐药性，为临床儿童急性下呼吸道感染诊治和推广流感嗜血菌疫苗接种提供实验数据。方法2006年1月至2009年12月来自重庆地区13842份急性下呼吸道感染患儿深部痰标本；常规方法培养分离鉴定细菌；药敏试验法采用K-B纸片法；β-内酰胺酶检测采用Nitrocefin纸片法。结果共分离获得1967株Hi，分离率为14．2％。6月～3岁组和3～5岁组的Hi分离率分别为21．8％和16．3％，小于6月组和大于5岁组的分离率为10．3％和6．6％。95．5％的分离株在≤5岁年龄段；有40.3％患儿同时合并其它病原菌感染；β-内酰胺酶阳性率为35．8％。Hi对阿莫西林／克拉维酸、头孢噻肟、头孢曲松、头孢他啶、头孢呋辛、氨曲南、亚胺培南、阿奇霉素、利福平、环丙沙星的耐药率均低于10％；对氨苄西林、四环素和氯霉素的耐药率分别为34．4％、33．4％、20．6％；对复方磺胺甲嗯唑耐药率（SXT）最高72．7％；β-内酰胺酶阳性组对复方磺胺甲嗯唑、氯霉素、四环素的耐药率（91．5％、52．8％、64．7％）明显高于阴性组（62．2％、2．7％、15．9％）。Hi对≥3种抗菌药物的多重耐药菌株占30．0％；有74．1％分离株分布在8个常见的耐药表型，其中SXT最多，占32．3％，氨苄西林耐药表型集中分布在产β-内酰胺酶组。结论≤5岁儿童是Hi感染易感人群；Hi产β-内酰胺酶是对氨苄西林产生耐药的主要机制；SXT已不宜用于Hi感染的经验用药，临床应关注Hi的多蓐耐药现象，并加强Hi对抗菌药物的耐药性监测。Objective To investigate the circumstance of antimicrobial resistance of Haemophilus influenzae （Hi） and provide instruction for preventation and pharmacological application, we analyzed data about antimicrobial resistance in children who suffered acute low respiratory tract infectious（ALRIs） in Chongqing during 2006-2009. Methods 13,842 ALRIs sputum samples were cultured in this study, antimicrobial susceptibility was tested by Kirby-Bauer method with 14 common antibiotic, and the beta-lactamases were detected by nitrocefin disk test. Results 1,967 Hi were identified from 13,842 ALRIs sputum samples, and the positive rate of Hi among all the clinical samples was 14.2%. All the samples were divided into 4 groups： younger than 6 months（group 1）, 6 months to 3 years（group 2）, 3 years to 5 years（group 3） and older than 5 years（group 4）. The positive rate in group 2（21.8%） and group 3 （16.3%） are higher than that in group 1 （10.3%） and group 4 （6.6%） statistically. Among all the 1,967 Hi, 95.5%（1,879） were identified from children no more than 5 years old. Beside Hi, 40.3% patients suffered multibacteria infection. The rate of beta-lactamase producing is 35.8%. Less than 10% of the isolates were resistant to amoxicillin/clavulanic acid, ceftazidime, cefotaxime, ceftriaxone, cefuroxime, aztreonam, imipenem, azithromycin , rifampicin and ciprofloxacin. Whereas, the resistant rates in SXT, ampicillin, tetracycline and chloramphenicol are 34.4%, 33.4% and 20.6% respectively. Further more drug-resistant to SXT（91.5%）, chloramphenieol（52.8%）, tetracycline（64.7%）, in beta-lactamase-positive group is higher than that（SXT 62.2%, chloramphenicol 2.7%, tetracycline 15.9%） in beta-laetamase-nonproducing group. Up to 30.0% of Hi were multidrug-resistant, and 74.1% of them can be divided into eight common resistant phenotype. Among them, SXT（32.3%） is the largest percentage and ampicillin resistant Hi most case combined with beta-lactamase positive phenotypes. Concl

关 键 词：流感嗜血菌 急性下呼吸道感染 Β-内酰胺酶 抗菌药物 耐药性 

分 类 号：R378.11[医药卫生—病原生物学]