云南地区儿童分离流感嗜血杆菌荚膜分型及耐药模式分析  

Capsular typing and drug resistance patterns of Haemophilus influenzae strains isolated from children in Yunnan

作　　者：袁梅 麻明彪 戍俊陶[2] 李珏 张建英[1] 孔宁 张霞 黄海林[1] YUAN Mei;MA Ming-biao;SHU Jun-tao;LI Jue;ZHANG Jian-ying;KONG-ning;ZHANG Xia;HUAN Hai-lin(Kunming Children′s Hospital,Kunming,Yunnan 650000,China)

机构地区：[1]昆明市儿童医院检验科,云南昆明650000 [2]昆明市儿童医院新生儿科,云南昆明650000 [3]昆明市儿童医院神经内科,云南昆明650000

出　　处：《中华医院感染学杂志》2021年第18期2826-2830,共5页Chinese Journal of Nosocomiology

基　　金：云南省教育厅科学研究基金资助项目(2020J0229);昆明市科技计划基金资助项目(2017-1-S-15214);昆明市卫生科技人才培养项目暨“十百千”工程基金资助项目(2021-SW-(后备)-70)。

摘　　要：目的调查云南地区患儿分离的流感嗜血杆菌(Hi)荚膜分型和耐药模式。方法对昆明市儿童医院2018-2019年分离的709株Hi进行抗菌药物敏感试验,头孢硝噻吩纸片法进行β内酰胺酶检测。随机选取148株Hi菌株,采用玻片凝集法进行血清荚膜分型,PCR法进行基因荚膜分型和耐药基因TEM、ROB、PBP3S和PBP3BLN检测。结果Hi最容易通过呼吸道侵犯5岁以下的男童,全年易感,春夏季检出率较高。产β内酰胺酶菌株检出率为58.5%,产酶菌株对氨苄西林、四环素、磺胺甲噁唑/甲氧苄啶、氯霉素、头孢呋辛、头孢克洛耐药率和多重耐药率均高于不产酶菌株(P<0.05)。β内酰胺酶阳性氨苄西林耐药(BLPAR)、β内酰胺酶阴性氨苄西林敏感(BLNAS)、β内酰胺酶阳性阿莫西林克拉维酸耐药(BLPACR)、β内酰胺酶阴性氨苄西林敏感(BLNAS)和β内酰胺酶阴性氨苄西林中介(BLNAI)耐药模式菌株分别为43.2%、26.8%、15.4%、14.2%和0.4%。血清荚膜分型结果显示,不可分型流感嗜血杆菌(NTHi)占89.2%,荚膜型Hib、Hie、Hif、Hic分别占6.1%、2.7%、1.3%、0.7%,基因荚膜分型结果与血清荚膜分型结果一致。TEM、PBP3BLN、PBP3S、ROB耐药基因检出率分别为54.1%、18.9%、11.8%、6.9%。不同耐药模式的耐药基因表达情况不尽相同。结论云南地区儿童易受Hi侵袭导致呼吸道感染,春夏季和男童更易发病;β内酰胺酶产酶率较高,耐药率较严重;本地区流行血清型是NTHi菌株;耐药模式以BLPAR较为流行;产TEM型β内酰胺酶为主要耐药机制。OBJECTIVE To investigate the capsular typing and drug resistance patterns of Haemophilus influenzae strains isolated from children in Yunnan.METHODS Drug susceptibility testing was performed for 709strains of H.influenzae strains isolated from Children′s Hospital Affiliated to Kunming Medical University in 2018-2019,β-lactamase was detected by using cephalosporin disc method.148strains of H.influenzae were randomly selected,the serum capsular typing was performed by using slide agglutination method,the capsular typing of genes and the drug resistance genes TEM,ROB,PBP3Sand PBP3BLN were detected by means of PCR.RESULTS The H.influenzae strains were more likely to invade male children less than 5years old through respiratory tract and were susceptible in all year round,the isolation rate was significatly higher in spring and summer.The isolation rate ofβ-lactamase-producing strains was 58.5%,the drug resistance rates of theβ-lactamase-producing strains to ampicillin,tetracycline,compound trimethoprim,chloramphenicol,cefuroxime and cefaclor were significatly higher than those of the strains without producingβ-lactamase,and multidrug-resistance rates of theβ-lactamaseproducing strains were significatly higher than those of the strains without producingβ-lactamase(P<0.05).β-lactamase-positive ampicillin-resistant(BLPAR)strains,β-lactamase-negative ampicillin-sensitive(BLNAS)strains,β-lactamase-positive amoxicillin-clavulanic acid-resistant(BLPACR),β-lactamase-negative ampicillin-sensitive(BLNAS)strains andβ-lactamase-negative ampicillin-intermediate(BLNAI)strains accounted for 43.2%,26.8%,15.4%,14.2%and 0.4%,respectively.The result of serum capsular typing showed that non-typeable Haemophilus influenzae(NTHi)accounted for 89.2%,and capsular types Hib,Hie,Hif,and Hic accounted for 6.1%,2.7%,1.3%,and 0.7%,respectively,the results of gene capsule typing were consistent with the results of serum capsule typing.The detection rates of the drug resistance genes TEM,PBP3BLN,PBP3S and ROB were 54.1%,18.9%,11.8%and

关 键 词：儿童 流感嗜血杆菌 荚膜分型 耐药模式 

分 类 号：R378[医药卫生—病原生物学]