临床标本嗜血菌BLNAR菌株的分离及其耐药性  

A surveillance report of detection rate and antimicrobial resistance to clinical isolates of BLNAR

作　　者：蔡淑梅[1] 陈保锦[1] 朱海平[1] 姚立琼[1] 刘志武[1] 金凤玲[1] 

机构地区：[1]兰州大学第一临床医学院,兰州730000

出　　处：《中国抗生素杂志》2015年第2期137-140,共4页Chinese Journal of Antibiotics

摘　　要：目的通过对我院2007年1月—2012年12月6年间嗜血菌BLNAR(β-lactamase-negative ampicillin-resistant)菌株构成比以及耐药性变化趋势分布调查分析,为临床呼吸系统感染性疾病的诊断和治疗及流行病学提供依据。方法用巧克力培养基对来自不同科室的标本进行分离培养,用卫星试验鉴别流感嗜血菌和副流感嗜血菌;用纸片扩散法进行10种抗菌药物的药敏试验,根据美国临床实验室标准化研究所(CLSI)药敏试验指南判断结果 ;采用头孢硝噻吩纸片法筛查氨苄西林耐药菌株β-内酰胺酶,结果阴性者确诊为BLNAR。将BLNAR和BLPAR(β-lactamase-positive ampicillin-resistant)嗜血菌进行耐药性对比并进行统计学分析。结果 6年共分离BLNAR 164株,BLNAR菌株的检出率和检出数呈总体上升趋势。流感嗜血菌对氨曲南、氨苄西林/舒巴坦的不敏感率明显高于BLPAR,且两者的不敏感率经卡方检验,P<0.05,具有统计学意义。副流感嗜血菌对复方磺胺甲噁唑、氨苄西林/舒巴坦、头孢曲松、氨曲南的耐药率明显高于BLPAR,且两者的耐药率经卡方检验,P<0.05,具有统计学意义。BLNAR菌株,无论是流感嗜血菌和副流感嗜血菌,对于阿奇霉素的的不敏感率却明显低于BLPAR菌株,且两者的不敏感率经卡方检验,P<0.05,具有统计学意义。其他药物,如美罗培南、左氧氟沙星、氯霉素、头孢呋辛等药物的耐药率或者不敏感率没有统计学上的差别。结论 本地区的BLNAR的发生率虽然不高,但其检出率、检出数有升高趋势。BLNAR嗜血菌对氨苄西林/舒巴坦、头孢曲松、氨曲南、阿奇霉素耐药率或者不敏感率与BLPAR,在统计学上,有明显的差异。BLNAR耐药机制和和耐药表型有待研究。Objective To investigate isolated rate and drug resistance of BLNAR from January, 2007 to December, 2012 in our hospital, and provide evidences for etiology diagnosis and treatment on respiratory tract infections and epidemiology. Methods Haemophilus selective medium was used to isolate and culture clinical samples from different sections, identify Haemophilus infiuenzae （Hi） and Haemophilus parainfiuenzae （Hp） by the satellites phenomenon, antimicrobial susceptibility testing was performed by Kirby-bauer disc diffusion method to detect 10 kinds of antibotics and β-lactamase was detected with nitrocefin disk testing, results were analyzed according to CSCL guideline, then making a comparison and statistical analysis between BLNAR and other Haemophilus. Results A total of 164 BLNAR isolates were collected, the annual number of detection and detection rate are increasing overall. The nonsusceptible rate or resistant rate of Hi BLNAR to ATM and SAM were higher than BLPAR. The nonsusceptible rate or resistant rate of Hp BLNAR to ATM, SAM, CRO, SXT, were higher than BLPAR. But the nonsusceptible rate of Hp BLNAR and Hi BLNAR to AZM were lower than Hp BLPAR and Hi BLPAR. There were not differences at CXM, MEM, LEV, CHL and so on. Conclusion We should worry about the annual detection numbers, detection rate BLNAR. There were some differences at ATM, SAM, CRO, SXT, AZM and so on. We still need more researches about the resistance mechanism and resistant phenotype.

关 键 词：BLPAR BLNAR 抗菌药物 耐药率 不敏感率 Β-内酰胺酶 

分 类 号：R378[医药卫生—病原生物学]