住院患儿感染流感嗜血杆菌的血清型和耐药特点分析  

Analysis of serotype distribution and antibiotic resistance of Haemophilus influenzae in hospitalized children

作　　者：李静[1] 周林[1] 徐文健[1] 马丽娟[1] Li Jing;Zhou Lin;Xu Wenjian;Ma Lijuan(Department of Clinical Laboratory,Children′s Hospital,Capital Institute of Pediatrics,Beijing 100020,China)

机构地区：[1]首都儿科研究所附属儿童医院检验中心,北京100020

出　　处：《中华实用儿科临床杂志》2022年第2期112-115,共4页Chinese Journal of Applied Clinical Pediatrics

摘　　要：目的探讨分离住院患儿流感嗜血杆菌血清型、耐药性及β-内酰胺酶基因型特征,为临床诊治提供参考。方法回顾性分析2016年1月至2018年12月首都儿科研究所附属儿童医院住院患儿临床培养分离的流感嗜血杆菌148株,应用乳胶凝集法进行荚膜血清分型,PCR法检测荚膜基因。E-test和纸片扩散法检测分离株对氨苄西林等抗菌药物的敏感性,采用χ^(2)检验进行耐药率的比较。头孢硝噻吩纸片法检测细菌产β-内酰胺酶表型,PCR法检测β-内酰胺酶基因TEM-1和ROB-1的携带情况。结果148株流感嗜血杆菌荚膜血清分型均为不可分型,未扩增出荚膜基因。菌株对氨苄西林、氨苄西林/舒巴坦、头孢呋辛和阿奇霉素的耐药率分别为68.9%(102/148株)、40.5%(60/148株)、53.4%(79/148株)和56.1%(83/148株),对甲氧苄啶-磺胺甲唑的耐药率最高,达91.9%(136/148株)。分离株对头孢曲松、美罗培南和左氧氟沙星100.0%(148/148株)敏感。β-内酰胺酶阳性菌株占64.8%(96/148株),基因型均为TEM-1。β-内酰胺酶阳性菌株对氨苄西林、氨苄西林/舒巴坦和阿奇霉素的耐药率显著高于β-内酰胺酶阴性菌株(χ;=123.222,27.973,70.273,均P<0.01)。结论不可分型流感嗜血杆菌是当前儿童临床感染分离株的主要型别。不可分型流感嗜血杆菌对氨苄西林耐药率较高,主要耐药机制为携带TEM-1基因。头孢曲松和美罗培南对流感嗜血杆菌保持着高度抗菌活性。Objective To explore the serotype,antibiotic resistance andβ-lactamase gene of Haemophilus influenzae strains isolated from hospitalized children,thus providing reference for clinical diagnosis and treatment.Methods A total of 148 Haemophilus influenzae strains collected from January 2016 to December 2018 in hospitalized children of Children′s Hospital,Capital Institute of Pediatrics were retrospectively analyzed.The serotype and genotype of Haemophilus influenzae strains were examined by slide agglutination test and PCR,respectively.The sensitivity of isolates to Ampicillin and other antimicrobials was detected by the E-test and disk diffusion methods.Theβ-lactamase phenotype was tested by nitrocefin disk method.The carrying ofβ-lactamase gene TEM-1 and ROB-1 were detected by PCR.The drug resistance rate was compared byχ2 test.Results All the 148 strains were nontypeable Haemophilus influenzae(NTHi),and capsular gene was not amplified.The rate of resistance to Ampicillin,Ampicillin/Sulbactam,Cefuroxime,and Azithromycin were 68.9%(102/148 strains),40.5%(60/148 strains),53.4%(79/148 strains)and 56.1%(83/148 strains),respectively.The Haemophilus influenzae isolates showed the highest resistance rate to Trimethoprim-sulfamethoxazole,which was up to 91.9%(136/148 strains).The sensitive rate of isolates to Ceftriaxone,Meropenem and Levofloxacin were all 100.0%(148/148 strains).The prevalence ofβ-lactamase was 64.8%(96/148 strains)in Haemophilus influenzae and the genotype was TEM-1.The drug resistance rates ofβ-lactamase positive strains to Ampicillin,Ampicillin/Sulbactam and Azithromycin were significantly higher than those of other strains(χ2=123.222,27.973,70.273,all P<0.01).Conclusions The most prevalent serotype of Haemophilus influenzae is NTHi in children.Haemophilus influenzae carried TEM-1 gene had a high positive rate ofβ-lactamase production,which was the main mechanism of drug resistance to Ampicillin.Ceftriaxone and Meropenem were the most active agents against Haemophilus influenzae.

关 键 词：流感嗜血杆菌 儿童 血清型 Β-内酰胺酶 耐药基因 

分 类 号：R446.5[医药卫生—诊断学]