2014年成都某院流感嗜血杆菌的临床分布及耐药分析  

Clinical distribution of Hemophilus influenzae and its drug resistance analysis

作　　者：罗宇鹏[1] 

机构地区：[1]成都市第五人民医院检验科,四川成都611130

出　　处：《国际检验医学杂志》2016年第3期333-335,共3页International Journal of Laboratory Medicine

摘　　要：目的探讨该院临床分离的流感嗜血杆菌分布及抗菌药物的耐药情况。方法以该院2014年1-12月所有已筛查合格且培养为阳性的下呼吸道标本1 895份、血液类标本666份、尿道分泌物标本102份,共2 663份标本分离出的流感嗜血杆菌438株为研究对象,采用头孢硝基噻吩纸片测定其β-内酰胺酶,用纸片扩散法（K-B法）测定其对8种抗菌药物的敏感性,利用WHONET5.6软件对试验数据进行统计分析。结果 438株流感嗜血杆菌中98.6%来自住院患者,1.4%来自门诊;儿童分离株有176株,占40.18%;老年患者分离株194株,占44.29%;下呼吸道标本来源434株,占99.09%。对复方磺胺甲噁唑耐药率最高,达82.90%,氨苄西林和四环素的耐药率分别为43.40%、29.00%;而头孢呋辛、头孢曲松、环丙沙星、阿奇霉素、亚胺培南的耐药率均在2.00%以下。β-内酰胺酶的阳性率为43.40%,在氨苄西林耐药菌株中有1.57%的菌株β-内酰胺酶检测阴性。儿童分离株对氨苄西林的耐药率和产酶率（42.40%、40.43%）和成人分离菌株对氨苄西林的耐药率及产酶率（44.00%、44.00%）没有明显差异。结论流感嗜血杆菌主要分离自下呼吸道标本中;以儿童和老年患者为主,第二、三代头孢菌素类与阿奇霉素可作为临床首选药物,β-内酰胺酶是该菌对氨苄西林耐药的主要机制。Objective To study the distribution of clinically separated Hemophilus （H.） influenzae and its drug resistance situation. Methods Among 2 663 specimens of screening qualified and positive culture collected from the outpatients,inpatients and e- mergency patients of our hospital from January to December 2014,including 1 895 specimens of lower respiratory tract, 666 blood specimens and 102 urinary secretion specimens,438 strains of H. influenzae were isolated. The cephalosporin nitro thiophene paper test strip was used to test its beta lactamase and the K-B method was used to detect its sensitivity to 8 kinds of antibacterial drugs. The testing data were statistically analyzed by using WHONET5.6 software. Results Among 438 strains of H. influenzae,98.60% was originated from hospitalized patients, 1.4% from the outpatient department;176 isolated strains were originated from children, accounting for 40.18% ;194 strains （44.29%） were from elderly patients, 434 strains（99.09%） were originated from the lower respiratory tract specimens. The resistance rate to compound sulfamethoxazole was highest and reached 82.90%, which to ampicillin and tetracycline were 29.00% and 43.40% respectively ; but which to cefuroxime, ceftriaxone, ciprofloxacin, azithromycin, imipenem were below 2.00 %. The β-lactamase positive rate was 43.40% ,in ampicillin resistant strains, 1.57% of strain was negative in β-lactamase test. The resistance to ampicillin and enzyme production rate had no significant differences between the children isolated strains and adult isolated strains （42.4%,42.40% vs. 44.00%,44.00%）. Conclusion H. influenzae is mainly isolated from lower respiratory tract specimens;which is dominated by children and elderly patients; the second and third＇generations of cephalosporins and azithromycin can serve as a clinical preferred drugs;β-lactamase is the primary mechanism of resistance to ampicillin.

关 键 词：流感嗜血杆菌 耐药性 抗菌药物 Β-内酰胺酶 

分 类 号：R446.5[医药卫生—诊断学]