2017-2019年山东省临床分离流感嗜血杆菌的耐药性监测  

Antimicrobial resistance surveillance in the Haemophilus influenzae strains isolated in Shandong Province from 2017 to 2019

作　　者：孙彦蒙 王梦园 李政[1] 王世富[1] 周卫萍 李仁哲[3] 陈艳萍 刘志伟[5] 孙淑红[6] 李艳华[7] 李宜雷[8] 李艳[9] 满思金[10] 李静[1] 寇琳娜 于文文 张春艳[1] SUN Yanmeng;WANG Mengyuan;LI Zheng;WANG Shifu;ZHOU Weiping;LI Renzhe;CHEN Yanping;LIU Zhiwei;SUN Shuhong;LI Yanhua;LI Yilei;LI Yan;MAN Sijin;LI Jing;KOU Linna;YU Wenwen;ZHANG Chunyan(Department of Clinical Microbiology,Children’s Hospital,Shandong University,Shandong Provincial Clinical Research Center for Children’s Health and Disease,Jinan 250022,China)

机构地区：[1]山东大学附属儿童医院临床微生物科,山东省儿童健康与疾病临床医学研究中心,济南250022 [2]临沂市妇女儿童医院检验科 [3]济宁市第一人民医院检验科 [4]青岛妇女儿童医院检验科 [5]泰安市妇幼保健院检验科 [6]临沂市人民医院检验科 [7]聊城市人民医院检验科 [8]日照市人民医院检验科 [9]枣庄市妇幼保健院检验科 [10]滕州市中心人民医院检验科

出　　处：《中国感染与化疗杂志》2023年第1期73-79,共7页Chinese Journal of Infection and Chemotherapy

基　　金：国家科技重大专项(2017ZX10103004-007)。

摘　　要：目的 分析山东地区临床分离流感嗜血杆菌的菌株分布特点及耐药性,促进临床对流感嗜血杆菌治疗药物的合理选择。方法 依托山东省儿童细菌&真菌耐药监测研究协作网,收集2017年1月1日—2019年12月31日山东省医疗单位临床分离的非重复流感嗜血杆菌,采用纸片扩散法或自动化仪器法按统一方案进行药敏试验,结果判读依照CLSI2022版M100抗微生物药物敏感性试验执行标准。使用WHONET 5.6和SPSS 22.0软件对数据进行分析。结果 共收集流感嗜血杆菌18 057株,多分离于痰、咽拭子、肺泡灌洗液等标本,感染呈季节性分布。2017—2019年氨苄西林耐药率为69.5%、76.4%、79.7%,β内酰胺酶阳性率为63.0%、72.1%、76.6%,β内酰胺酶阴性氨苄西林耐药的流感嗜血杆菌(BLNAR)占比分别为9.7%、7.9%、7.3%。对氨苄西林、氨苄西林-舒巴坦、头孢呋辛耐药率均呈逐年上升趋势,对氯霉素、亚胺培南、美罗培南、左氧氟沙星的耐药率均呈现逐年下降的趋势。结论 山东省流感嗜血杆菌对氨苄西林的耐药率>60%,BLNAR的均值高达8.1%,据此氨苄西林不宜为治疗流感嗜血杆菌的临床首选药物;对第三代头孢菌素的耐药率低,宜作为流感嗜血杆菌治疗的首选药物。该菌对临床儿童常用抗生素耐药形势严峻,亟需加强其耐药监测,从而指导临床合理使用抗菌药物以减缓流感嗜血杆菌的耐药。Objective To analyze the distribution and antimicrobial resistance profiles of clinical isolates of Haemophilus influenzae in Shandong province, so as to promote rational antimicrobial therapy for H. influenzae. Methods From January 1,2017 to December 31, 2019, 18 057 nonduplicate clinical strains of H. influenzae were collected from Shandong Province Pediatric Antimicrobial & Antifungal Resistance Surveillance System. Antimicrobial susceptibility test was conducted by disk diffusion method or automatic systems according to a unified protocol. The results were interpreted using CLSI breakpoints(2022 Edition,M100-S31). Data were analyzed using WHONET 5.6 and SPSS 22.0 softwares. Results Most of the 18 057 strains of H. influenzae were isolated from sputum, nasopharynx swabs, and bronchoalveolar lavage fluid. From 2017 to 2019, 69.5%, 76.4% and 79.7%of the strains were resistant to ampicillin. The prevalence of β-lactamase-producing strains was 63.0%, 72.1% and 76.6% in the 3years. The prevalence of β-lactamase-negative ampicillin-resistant(BLNAR) strains was 9.7%, 7.9% and 7.3%, respectively. The strains showed increasing resistance rates to ampicillin, ampicillin-sulbactam and cefuroxime, but decreasing resitance rates to chloramphenicol, imipenem, meropenem and levofloxacin from 2017 to 2019. Conclusions The prevalence of ampicillin-resistant H. influenzae was 60% or higher during the period from 2017 to 2019 in Shandong Province. The mean prevalence of BLNAR was 8.1%. Therefore, ampicillin should not be taken as the first choice for treatment of H. influenzae. The H. influenzae strains showed high susceptibility rate to third generation cephalosporins. So third generation cephalosporins should be used as the first choice for the treatment of H. influenzae. It is urgent to strengthen the monitoring of antimicrobial resistance of H. influenzae to the antibiotics commonly used in children to improve rational use of antimicrobial agents and contain H. influenzae resistance in clinical practice.

关 键 词：流感嗜血杆菌 Β内酰胺酶 耐药性监测 

分 类 号：R378.4[医药卫生—病原生物学]