2018年乌鲁木齐儿童医院分离的225株肺炎链球菌血清型和耐药性研究  

Serotype distribution and antibiotic resistance pattern of 225 Streptococcus pneumoniae isolates from Urumqi Children′s Hospital in 2018

作　　者：田居灵 刘丹丹 施兴海 高薇 袁林 贾举 张文利 姚开虎 Tian Juling;Liu Dandan;Shi Xinghai;Gao Wei;Yuan Lin;Jia Ju;Zhang Wenli;Yao Kaihu(Medical Laboratory,Urumqi Children′s Hospital,Urumqi 830002,China;National Center for Children′s Health,Beijing Children′s Hospital,Capital Medical University,Beijing Pediatric Research Institute,Laboratory of Microbiology,Key Laboratory of Major Diseases in Children,Ministry of Education,Beijing 100045,China)

机构地区：[1]乌鲁木齐儿童医院医学检验科,乌鲁木齐830002 [2]国家儿童医学中心,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,教育部儿科重大疾病研究重点实验室,北京100045

出　　处：《中华实用儿科临床杂志》2020年第8期590-594,共5页Chinese Journal of Applied Clinical Pediatrics

基　　金：国家自然科学基金(81371853)。

摘　　要：目的了解乌鲁木齐儿童医院分离的肺炎链球菌分离株的血清型分布和耐药状况,评估使用13价肺炎链球菌结合疫苗(PCV13)预防感染和控制耐药流行的潜在价值。方法复苏2018年1-12月乌鲁木齐儿童医院检验科分离的肺炎链球菌。采用荚膜肿胀试验检测血清型,评估PCV13覆盖率。采用E-test法检测分离株对青霉素、阿莫西林、头孢噻肟、头孢曲松的最低抑菌浓度(MIC),并采用梅里埃VITEK 2 Compact全自动细菌鉴定及药敏分析系统检测美罗培南等其他9种抗菌药物的敏感性。结果共成功复苏225株肺炎链球菌。常见血清型为19F(32.9%)、23F(12.0%)、19A(10.7%)、6B(10.2%)和6A型(8.0%)。PCV13覆盖率为80.4%。<2岁和≥2岁患儿分离株之间,以及汉族和少数民族患儿分离株,血清型分布未见明显不同,PCV13覆盖率也相似。分离株对口服青霉素的中介率和耐药率分别为57.8%和31.7%。以脑膜炎界值判断,胃肠外青霉素耐药率高达89.4%,对头孢曲松和头孢噻肟不敏感率达47.5%和64.6%,以中介为主。菌株对红霉素、复方磺胺甲唑、四环素耐药率高,分别达98.1%、67.6%和89.6%,对阿莫西林、美罗培南、左氧氟沙星和莫西沙星敏感率均超过90%。PCV13型菌株对青霉素的耐药性较非PCV13型菌株更强。结论乌鲁木齐地区儿科肺炎链球菌分离株以19F、23F、19A、6B和6A型常见,PCV13型覆盖率约80%,汉族和少数民族儿童分离株血清型分布未见明显差异。菌株对红霉素普遍耐药,临床考虑肺炎链球菌脑膜炎时,应注意菌株对青霉素等耐药率高。推广使用PCV13可有效预防儿童肺炎链球菌感染和耐药菌株的播散。Objective To investigate the serotype distribution and drug resistance of Streptococcus pneumoniae(S.pneumoniae)isolated in Urumqi Children′s Hospital and to evaluate the significances of 13-valent pneumococcal conjugate vaccine(PCV13)in preventing infection and controlling drug resistance.Methods The S.pneumoniae isolates stored in clinical laboratory of Urumqi Children′s Hospital from January to December in 2018 were re-cultured.The serotypes were detected by capsule swelling experiment to assess the coverage rate of PCV13.The minimum inhibitory concentration(MIC)of Penicillin,Amoxicillin,Cefotaxime and Ceftriaxone were detected by E-test method,and the susceptibility of the isolates to Meropenem and other 9 antibiotics was detected by VITEC 2 Compact system.Results A total of 225 S.pneumoniae strains were identified.The common serotypes were 19F(32.9%),23F(12.0%),19A(10.7%),6B(10.2%)and 6A(8.0%).PCV13 coverage rate was 80.4%.There was no significant difference in serotype distribution and PCV13 coverage between children<2 years old and≥2 years old,as well as between Han and minority people.The 57.8%and 31.7%strains showed intermediate susceptibility and resistance against oral Penicillin,respectively.Based on the breakpoints for meningitis,89.4%strains were resistant against pare-nteral Penicillin,and 47.5%and 64.6%strains were non-susceptible(mainly intermediately susceptible)to Ceftria-xone and Cefotaxime,respectively.The resistance rates of strains against Erythromycin,Sulfamethoxazole-trimethoprim and Tetracycline were as high as 98.1%,67.6%and 89.6%,respectively.More than 90%tested isolates were susceptible to Amoxicillin,Meropenem,Levofloxacin or Moxifloxacin.PCV13 strains were more resistant to Penicillin than non-PCV13 strains.Conclusions The serotypes 19F,23F,19A,6B and 6A are common among the S.pneumoniae isolated in Urumqi.The coverage rate of PCV13 is about 80%.There was no significant difference in serotype distribution between Han and minority nationality children.S.pneumoniae were frequent

关 键 词：肺炎链球菌 血清型 耐药性 儿童 

分 类 号：R72[医药卫生—儿科] R446[医药卫生—临床医学]