上呼吸道感染儿童鼻咽部携带肺炎链球菌状况及血清型和耐药性研究  

Nasopharyngeal carriage rate,antimicrobial resistance and serotype distribution of Streptococcus pneumoniae among children with upper respiratory infection

作　　者：俞桑洁[1] 高薇[1] 史伟[1] 袁林[1] 申阿东[1] 姚开虎[1] 杨永弘[1] 

机构地区：[1]首都医科大学附属北京儿童医院、北京市儿科研究所微生物研究室、儿科学国家重点学科、教育部儿科重大疾病研究重点实验室,北京100045

出　　处：《中国当代儿科杂志》2014年第10期988-992,共5页Chinese Journal of Contemporary Pediatrics

基　　金：首都卫生发展科研专项项目重点攻关(项目编号首发2011-2009-05);北京市科委行业定额经费自主项目(2014-bjsekyjs-3)

摘　　要：目的了解上呼吸道感染儿童鼻咽部携带肺炎链球菌状况,以及分离株的耐药性和血清型分布。方法 2013年3月至2014年2月采集在北京儿童医院门诊就诊的上呼吸道感染儿童鼻咽拭子进行细菌培养和鉴定,采用Etest方法检测抗生素敏感性,荚膜肿胀试验检测血清型。结果共采集到2 941例1月龄至16岁患儿的鼻咽拭子,分离出肺炎链球菌699株,携带率为23.8%。随机选取100株菌检测了抗生素敏感性和血清型。分离株对静脉青霉素敏感率达98.0%,口服青霉素敏感率仅为33.0%,头孢克洛耐药率为54.0%,头孢曲松和亚胺培南中介率也分别达到18.0%和38.0%。红霉素和阿奇霉素不敏感率均为97.0%。多重耐药率为86.0%。常见血清型为6A(12.0%)、19F(12.0%)、6B(10.0%)、23F(9.0%)和14型(8.0%),7、10和13价结合疫苗覆盖率分别为41.0%、42.0%和59.0%。结论门诊上呼吸道感染儿童中,鼻咽部肺炎链球菌携带率约为25%,抗生素耐药分离株常见,13价结合疫苗覆盖率接近60.0%。Objective To investigate nasopharyngeal carriage rate, antimicrobial resistance and serotype distribution of Streptococcus pneumoniae among children with upper respiratory infection. Methods Nasopharygeal swabs were collected from children with upper respiratory infection visiting the outpatient department of Beijing Children＇s Hospital between March 2013 and February 2014. The antibiotic susceptibility was tested by Etest method, and the serotype was determined by Quellung reaction. Results The nasopharyngeal carriage rate for Streptococcus pneumoniae was 23.8%（699/2 941）. One hundred isolates were randomly chosen for antimicrobial susceptiblity test and serotyping. Up to 98.0%isolates were susceptible to parenteral penicillin. The susceptible rate against oral penicillin, however, was 33.0%. The non-susceptible rate to erythromycin and azithromycin was 97.0%. The multi-drug resistance rate was up to 86.0%. The common serotypes were 6A（12.0%）, 19F（12.0%）, 6B（10.0%）, 23F（9.0%） and 14（8.0%）. The coverage rates of 7-, 10-and 13-valent pneumococcal conjugate vaccine were 41.0%, 42.0%and 59.0%respectively. Conclusions About 25%of children with upper respiratory infection are nasopharyngeal colonized by Streptococcus pneumoniae. The isolates show a high antimicrobial resistance. The 13-valent pneumococcal conjugate vaccine covers about 60.0%of the isolates.

关 键 词：肺炎链球菌 携带率 抗生素耐药 血清分型 儿童 

分 类 号：R446.5[医药卫生—诊断学]