2009-2013年重庆地区儿童感染流感嗜血杆菌的耐药性及血清型分析  

Antimicrobial resistance and serotype of Haemophilus influenzae isolates from Chongqing children during 2009 to 2013

作　　者：景春梅[1] 王偲[1] 

机构地区：[1]重庆医科大学附属儿童医院检验科儿童发育疾病研究教育部重点实验室儿科学重庆市重点实验室重庆市儿童发育重大疾病诊治与预防国际科技合作基地,重庆400014

出　　处：《第三军医大学学报》2014年第23期2400-2403,共4页Journal of Third Military Medical University

基　　金：国家自然科学基金(81071417)~~

摘　　要：目的统计分析2009-2013年重庆地区儿童感染流感嗜血杆菌（Haemophilus influenzae,Hi）的耐药性及血清型,为临床治疗Hi感染和推广Hi疫苗接种提供参考依据。方法纸片扩散法检测Hi的耐药性,玻片凝集法对Hi进行血清分型。结果共分离Hi 5 474株,以呼吸道标本多见,占97.4%（5 329株）。〉6个月-3岁组和〉3-5岁组的Hi分离率分别为21.8%和16.3%,高于〈6个月组和〉5岁组的分离率10.3%和6.6%,82.2%的分离株在≤5岁年龄段;复方新诺明、氨苄西林、头孢噻肟、氨苄西林/舒巴坦、左氧氟沙星的耐药率分别为77.0%、42.4%、0.2%、2.3%、0.4%。2009-2013年Hi对复方新诺明、阿莫西林/棒酸、氨苄西林、氯霉素、利福平、头孢呋辛、阿奇霉素耐药率有明显改变（P〈0.05）,其余受试药物的耐药率均无明显改变（P〉0.05）。共分离出33株β-内酰胺酶阴性氨苄西林耐药Hi,占0.6%。2282株Hi产β-内酰胺酶,产酶率为41.7%。不可分型Hi占92.8%,可分型Hi中a、b、c型各占5.6%,d、e、f型分别为27.8%、38.9%、16.7%。结论≤5岁儿童是Hi感染易感人群,Hi主要分离自呼吸道标本,复方新诺明已不宜用于Hi感染的经验用药,临床应重视Hi的耐药现象,并加强Hi对抗菌药物的耐药性监测。血清分型以不可分型株为主,Hie是重庆地区儿童Hi的主要血清型。Objective To investigate the antimicrobial resistance and serotype of Haemophilus influenzae（ Hi） isolates from the children in Chongqing during the year of 2009 to 2013, and provide instruction for prevention and pharmacological application. Methods Antimicrobial susceptibility testing was performed by Kirby-Bauer disc diffusion method,and serotypes were measured by Hi antiserum. Results A total of 5 474 Hi isolates were collected,97. 4%（ 5 329 isolates） were from respiratory samples. All the samples were divided into 4 groups according to the children’s ages,that is,younger than 6 months（ group1）,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%） were significantly higher than that in group 1（ 10. 3%） and group 4（ 6. 6%）. Among all the 5 474 Hi strains,82. 2% were identified from children younger than 5 years old. The resistant rate to trimethoprim-sulfamethoxazole, ampicillin, cefotaxime,ampicillin / sulbactam,levofloxacin was 77. 0% 42. 4%,0. 2 %,2. 3% and 0. 4%,respectively. There were significant changes among the resistance rates of trimethoprim-sulfamethoxazole,amoxycillin-clavulanic acid,ampicillin,chloramphenicol,rifampicin,cefuroxime,and azithromycin during the investigation period（ P 〈0. 05）. However,the difference of resistance rates of the rest antibiotics had no statistically significance（ P 〉0. 05）. A total of 33 isolates（ 0. 6%） were beta-lactamase negative ampicillin-resistant（ BLNAR） Hi. Total2 282 isolates（ 41. 7%） produced beta-lactamase. Nontypeable Haemophilus influenzae（ NTHi） accounted for92. 8% among all Hi strains,and Hia,Hib,Hic,Hid,Hie,and Hif accounted for 5. 6%,5. 6%,5. 6%,27. 8%,38. 9%,and 16. 7% respectively among all serotype of Hi. Conclusion Children younger than 5 years old are sensitive population for Hi infection. Most of Hi are isolated from respiratory samples,and trimethoprimsulfamethoxazole is not suita

关 键 词：流感嗜血杆菌 耐药性 血清型 Β-内酰胺酶 儿童 

分 类 号：R181.36[医药卫生—流行病学] R373.13[医药卫生—公共卫生与预防医学]