2007-2010年上海市社区医院呼吸道感染常见病原菌及其耐药性调查  

Antimicrobiai susceptibility of community-acquired respiratory tract pathogens isolated from patientsin primary hospitals in Shanghai from 2007 to 2010

作　　者：周春妹[1] 胡必杰[1] 高晓东[1] 鲍容[1] 谢红梅[1] 黄声雷[1] 陶黎黎[1] 何礼贤[1] 

机构地区：[1]复旦大学附属中山医院临床微生物室,上海200032

出　　处：《中华结核和呼吸杂志》2013年第5期346-350,共5页Chinese Journal of Tuberculosis and Respiratory Diseases

摘　　要：目的 了解上海地区社区医院社区获得性呼吸道感染的常见病原菌分布及其对社区常用抗菌药物的耐药现状。方法收集2007年12月至2010年7月在上海市30所一级医院门诊和急诊就诊且疑似细菌性社区呼吸道感染的病例，入组条件为2周内未使用过抗菌药物。记录患者的体温、白细胞总数和中性粒细胞比例，并采集患者的Ⅱ囡拭子或痰标本送检。标本采集后2h内快递至中山医院微生物实验室进行细菌培养。采用琼脂稀释法测定青霉素G、阿莫西林、头孢拉定、头孢氨苄、头孢羟氦苄、磺胺甲嗯唑／甲氧苄啶和阿奇霉素对分离菌株的MIC值。结果30所医院共收集有效病例806例，体温≥38℃者占51．7％（417／806），白细胞计数≥10×10^9/L者占68．5％（552／806）。从688例上呼吸道感染患者中分离到细菌184株，最常见的细菌为流感嗜血杆菌（44株，23．9％）、金黄色葡萄球菌（44株，23．9％）和G群链球菌（43株，23．0％）。从118例下呼吸道感染患者中共分离到细菌33株，常见的细菌为流感嗜血杆菌（21株，63．6％）、G群链球菌（6株，18．2％）和肺炎链球菌（3株，9．1％）。药敏试验结果显示，流感嗜血杆菌对阿奇霉素的敏感度为100％，肺炎链球菌对青霉素G的敏感度高达94．1％（16／17株），而对阿奇霉素的敏感度仅为23．5％（4／17株）。头孢氨苄、头孢羟氨苄和头孢拉定对A群、B群和G群链球菌的MIC90≤42mg／L。结论社区获得性呼吸道感染以上呼吸道感染多虬，礼区常用基本药物对常见的致病菌仍保持较高的敏感度，但肺炎链球菌对大环内酯类药物的敏感度较低，单用大环内酯类药物治疗社区感染患者时需谨慎。Objective To investigate the etiology of community-acquired respiratory tract infections （CARTI） and the antimicrobial resistance of the major pathogens in primary hospitals in Shanghai. Methods Patients with CARTI were prospectively recruited from 30 primary hospitals fi＇om December 2007 to July 2010. Those who had used antimicrobiais within previous 2 weeks were excluded from the study. The clinical information such as temperature, white blood cell （WBC） count and percentage of neutrophils was recorded, and throat swab or deep cough sputum was collected to isolate pathogens. The specimens were collected and couriered to the Zhongshan Hospital microbiology laboratory within 2 h for bacterial culture. The minimal inhibition concentrations （MIC） of penicillin G, amoxicillin, cephradine, cephalexin, cefadroxil, sulfamethoxazole/trimethoprim and azithromycin were determined using the agar dilution test. Results Totally 806 qualified cases were enrolled in this study. Fever （ T i〉 38 ~C ） was present in 51.7% （ n = 417）, and increased WBC count （ 〉 10 x 109/L） was noted in 68.5% （n =552 cases）of the patients. For bacterial culture, 184 strains were isolated from throat swabs of 688 patients with upper respiratory infection ; the most frequently isolated bacteria were Haemophilus influenzae （44, 23.9% ）, Staphylococcus aureus （44, 23.9% ） and Group G streptococcus （43, 23.0% ）. Thirty-three strains were isolated from 118 patients with lower respiratory infections, with Haemophilus influenza （ 21, 63.6% ） , Group G streptococcus （6,18.2%） and Streptococcus pneumoniae （3,9. 1% ） as the leading pathogens. All strains of Haemophilus influenzae were susceptible to azithromycin. The susceptibility rate of Streptococcus pneumoniae to penicillinwas as high as 94. 7% , while that to azithromycin was significantly decreased （21.1%）. The MIC90 values of cephalexin, cefadroxil and ceftazidime for β-hemolytic streptococcus spp were ≤2 mg/L. Conclusions Upper respirat

关 键 词：呼吸道感染 细菌感染 抗菌药 微生物敏感性试验 

分 类 号：R446.5[医药卫生—诊断学]