广州地区上呼吸道感染儿童肺炎链球菌耐药状况  

Condition of resistant of Streptococcous pneumoniae in children

作　　者：邓秋连[1] 邓力[1] 叶启慈[1] 陈卓瑶[1] 谢永强[1] 陈树生[1] 

机构地区：[1]广州市儿童医院检验科,510120

出　　处：《实用医学杂志》2004年第3期322-323,共2页The Journal of Practical Medicine

摘　　要：目的 :了解广州地区肺炎链球菌的耐药情况 ,给临床合理用药提供重要依据。方法 :用鼻咽拭子采取2 0 0 0年 1月至 2 0 0 2年 12月我院呼吸科门诊及住院急性上呼吸道感染患儿鼻咽分泌物 ,划线接种于肺炎链球菌选择性培养基进行分离培养 ;用Etest法检测 3 2 7株肺炎链球菌对阿莫西林 /克拉维酸、青霉素、头孢曲松、头孢呋辛、头孢克洛和红霉素的耐药性 ,用K B法检测肺炎链球菌对氯霉素、四环素、克林霉素、复方新诺明的耐药性。结果 :广州地区上呼吸道感染儿童鼻咽部肺炎链球菌中 12 6%为低水平PRSP株 ;3 2 7株肺炎链球菌对阿莫西林 /克拉维酸除 2株中介外其他都敏感 ,对青霉素、头孢曲松、头孢呋辛、头孢克洛、红霉素、四环素、氯霉素、复方新诺明、克林霉素耐药率分别为 5 1 4%、0 6%、2 2 0 %、2 8 1%、80 5 %、75 7%、2 0 3 %、75 7%、5 9 4%。多重耐药发生率为75 % ,PNSP和PSSP菌株中多重耐药率分别为 89 3 % (15 0 /168)和 5 6 1% (90 /15 9) ,差异有显著意义 (χ2 =45 64 ,P<0 0 0 5 )。结论 :广州地区上呼吸道感染儿童鼻咽部肺炎链球菌耐药情况比较严重 ,并出现严重的多重耐药性 ,临床治疗儿童肺炎链球菌感染应首选 β 内酰胺类抗生素及加酶抑制剂的复合药物。Objective To investigate the situation of antibiotic resistance of Streptococcous pneumoniae for clinical isolate among Guangzhou Chinese children. Methods We cultured, isolated and identified Streptococcous pneumoniae from patients who visited Guangzhou children's Hospital with respiratory infection. Tests of antibiotic susceptibility were done for these clinical isolates by K B and E test. Results The penicillin resistant Sp (PRSP) isolated accunted for 12 6%. Of 327 strains of Streptococcous pneumoniae, augmentin and ceftriaxone being the most powerful. The rate of drug resistance of Streptococcous pneumoniae to augmentin, cefaclor, ceftriaxone, cefuroxime, penicillin, erythromycin, tetracycline, chloramphenicol Clindamycin and TMP SMX, were 0,28 1%,0 6%,22 0%,12 6%,80 5%,75 7%,20 3%,59 4%,75 7%, 89 3% of PNSP and 56 1% of PSSP were characterized by a multi resistance to erythromycin, tetracycline, chloramphenicol and TMP SMX, the disparity is notable very much ( χ 2 =45 64, P <0 005). Conclusion The resistant Streptococcous pneumoniae isolated from Children with respiratory tract infection in Guangzhou would be a severe problem. The isolation rate of penicillin resistant Streptococcous pneumoniae was not high among children in Guangzhou, but PRSP rate was increased and was characterized by a multi resistance to erythromycin, tetracycline, chloramphenicol and TMP SMX.

关 键 词：广州 上呼吸道感染 儿童 肺炎链球菌 耐药 合理用药 Β-内酰胺 药敏试验 

分 类 号：R446.5[医药卫生—诊断学]