2016~2020年石家庄地区儿童急性化脓性中耳炎主要病原菌耐药性变迁及流感嗜血杆菌的血清型分布  

Changes of drug resistance of main pathogenic bacteria of children with acute suppurative otitis media in Shijiazhuang from 2016 to 2020 and serotyping of Haemophilus influenzae

作　　者：于文静[1] 李梅[1] 郭映辉[1] 张文超[1] 周珊珊[1] 徐茜茹 刘雪超[1] YU Wenjing;LI Mei;GUO Yinghui;ZHANG Wenchao;ZHOU Shanshan;XU Qianru;LIU Xuechao(Department of Clinical Laboratory,Children's Hospital of Hebei Province Affiliated to Hebei Medical University,Shijiazhuang,Hebei,050031,China)

机构地区：[1]河北省儿童医院检验科,河北石家庄050031

出　　处：《中国耳鼻咽喉头颈外科》2022年第11期699-702,共4页Chinese Archives of Otolaryngology-Head and Neck Surgery

基　　金：河北省科技计划项目(182777177);河北省医学科学研究重点课题计划(20190823)。

摘　　要：目的 了解2016~2020年石家庄地区儿童急性化脓性中耳炎主要病原菌耐药性变迁及流感嗜血杆菌的分型,为临床合理用药提供依据。方法 收集河北省儿童医院2016年1月~2020年12月门诊和住院的544例急性化脓性中耳炎患儿的耳脓性分泌物,培养鉴定及检测药物敏感性。应用血清荚膜分型法对流感嗜血杆菌进行血清分型。结果 544例耳脓性分泌物标本中细菌培养阳性392例,阳性率为72.1%,各年间病原菌阳性检出率差异无统计学意义(χ^(2)=1.862,P=0.761)。儿童急性化脓性中耳炎常见致病菌是金黄色葡萄球菌,检出率为37.7%(148/392),其次是肺炎链球菌,检出率为26.3%(103/392)和流感嗜血杆菌,检出率为15.1%(59/392)。急性化脓性中耳炎患儿分为0~1岁、1~3岁、3~6岁、>6岁4个年龄段,各年龄段病原菌阳性检出率差异有统计学意义(χ^(2)=21.737,P=0.001),其中0~1岁患儿病原菌阳性检出率最高。5年间肺炎链球菌对红霉素、四环素和复方新诺明的耐药率较高均>75%。除2016年外,金黄色葡萄球菌对青霉素、红霉素、克林霉素的耐药率均>80%。流感嗜血杆菌对氨苄西林的耐药率为20.0%~57.1%,对复方新诺明的耐药率较高为45%~80%。59株流感嗜血杆菌中49株为不可分型流感嗜血杆菌。结论2016~2020年5年内石家庄地区引起儿童急性化脓性中耳炎的病原菌主要是金黄色葡萄球菌、肺炎链球菌和流感嗜血杆菌,这些病原菌对多种抗菌药物存在不同程度耐药,应定期监测本地区耐药情况,为临床医师合理选用抗菌药物提供依据。OBJECTIVE To investigate the antimicrobial susceptibility patterns of principal pathogens isolates and the classification of Haemophilus influenzae from children with acute suppurative otitis media in Shijiazhuang from 2016 to 2020,and to provide basis for rational clinical drug use.METHODS A total of 544 strains of pathogens isolated from outpatient and hospitalized children with acute suppurative otitis media aged 0 to 15 years old in Children’s Hospital of Hebei Province from January 2016 to December 2020 were collected.Identification and antimicrobial sensitivity of the strains were preformed,and the serotype of Haemophilus influenzae was tested by serocapsular typing.RESULTS Among 544 cases of purulent ear secretions,392 cases of pathogenic bacteria were detected,with a detection rate of 72.1%.There was no significant difference in the detection rate of pathogenic bacteria between years(χ^(2)=1.862,P=0.761).The most common strains were Staphylococcus aureus with a detection rate of 37.7%(148/392),followed by Streptococcus pneumoniae with a detection rate of 26.3%(103/392) and Haemophilus influenzae with a detection rate of 15.1%(59/392).Children with acute suppurative otitis media were divided into four age groups:0-1 years old,1-3 years old,3-6 years old and >6 years old.There were statistically significant differences in the detection rates of pathogen in the four age groups(χ^(2)=21.737,P=0.001),and the highest positive detection rate at 0-1 years old.The drug resistance rates of Streptococcus pneumoniae to erythromycin,tetracycline and cotrimoxazole were higher than 75% from 2016 to 2020.Except in 2016,the drug resistance rates of Staphylococcus aureus to penicillin,erythromycin and clindamycin were all >80%.The resistance rate of Haemophilus influenzae to ampicillin was 20.0%-57.1% and to cotrimoxazole was 45% to 80%.Fifty-nine strains of Haemophilus influenzae were serotyped,of which 49 were nontypeable Haemophilus influenzae.CONCLUSION In the five years from 2016 to 2020,Staphylococcus aureus,Stre

关 键 词：儿童 中耳炎 化脓性 耐药性 血清分型 病原菌 

分 类 号：R446.5[医药卫生—诊断学] R764.21[医药卫生—临床医学]