摘要
目的探讨我国不同地区医院儿科主要革兰阳性球菌耐药的情况。方法对2000年1月1日至2006年12月31日5所儿童专科医院检验科报送检标本分离出的4种革兰阳性球菌用Kirby-Bauer琼脂扩散法进行抗生素敏感实验。结果5所医院临床分离出金黄色葡萄球菌共7825株,其中耐甲氧西林金黄色葡萄球菌(methicillin-resistant staphylococcus aureus,MRSA)的检出率为6.87%,红霉素总耐药率为66.39%,并且有逐年上升趋势,未发现对万古霉素耐药或中度敏感菌株。分离出肺炎链球菌4781株,其中青霉素不敏感肺炎链球菌(PNSP)的平均检出率为68.64%,红霉素耐药率为90.80%,两者耐药率均逐年上升。分离出1301株β溶血性链球菌,对青霉素全部敏感,对红霉素的耐药率为80.94%,且耐药率在逐年增加。分离出肠球菌共2216株,对万古霉素的中度敏感率为3.11%,氨苄西林的耐药率为48.03%,红霉素的耐药率高达86.47%。结论除β溶血性链球菌外,多数革兰阳性菌对广谱青霉素的耐药率都偏高;对红霉素的耐药率居高不下并有逐年上升的趋势,革兰阳性菌对万古霉素和环丙沙星的敏感率较高。MRSA仍在较低水平,本研究未发现耐万古霉素金黄色葡萄球菌(VRSA),但出现对万古霉素中度敏感耐药的肠球菌。因此要加强对革兰阳性球菌耐药性和抗生素使用情况的监测,合理使用抗生素。
Objective To obtain a better insight of the drug-resistance rate of gram-positive cocci isolated from patients of 5 pediatric hospitals located in different areas of China. Methods From Jan 1st 2000 to Dec 31st 2006, a total of four type pathogenic strains were isolated from 5 pediatric hospitals which are Beijing Children＇ s Hospital, Children＇ s Hospital of Fudan University, Shanghai Children＇s Hospital, Guangzhou Children＇s Hospital and Chongqing Children＇s Hospital with both hospital acquired infection（HAI） and community acquired infection（CAI）, and the number of the strains is 8 215. The all 12 063 strains were tested using Kirby-Bauer method. According to the criteria of guidelines of NCCLS of each year from 2000 to 2006, the R% were calculated to show the resistance and intermediate, and the S% for susceptible rate of bacteria to the compound tested. We chose Penicillin, Oxacillin, Amoxicillin and Clavulanat, Clindamycin, Cefuroxime, Ceftriaxone, Erythromycin, Compound Sulfamethoxazole and Vancomycin for testing S. aureus; Penicillin, Erythromycin, Clindamycin, Vancomycin, Ofloxacin and Compound Sulfamethoxazole for testing S. pneumoniae ; Penicillin, Erythromycin , Clindamycin , Vancomycin and Ofloxacin for testing Group A streptococci ; Ampicillin , Streptomycin （ high concentration）, Gentamycin （high concentration, Ciprofloxacin, Vancomycin, Teicoplanin, Erythromycin and Rifampicin for testing Enterococcus. Results Among a total of 4 781 strains of S. aureus, the detectable rates of methicilin-resistant Staphylococcus aureus （MRSA） were 6.87% , and the rate of resistance to ervthromvcin was 66.39% while the rate was rising. The rate of MRSA from two hospitals in Shanghai were higher than the others. All S. aureus isolates were susceptible to vancomycin; 4 781 strains of S. pneumoniae were isolated. The rate of penicillin unsusceptible Streptococcus pneumoniae （PRSP） was 68. 64% , and the rate of resistance to erythromycin was 90.80% while the rate of both were going up; The total strains of 1 301 Group A streptococci were all susceptible to penicillin, with the rate of resistance to erythromyein was 80.94% which was rising by year, and we can see that rate of erythromycinresistant were various from 100% to 52.08% by area： 3. 11% of all 1377 isolated Enterocoeeus strains were found intermediate to vancomycin, and the rate of ampicillin resistance was 48.03%. The rate of resistance to erythromycin was 86.47%. Conclusion Except Group A streptococci, G^＋ coccus have a high resistance rate to penicillin; almost all G^＋ coccus were susceptible to vancomycin and teicomycin, but resistant to ervthromvcin with a trend of rising. MRSA was low in rate,and we haven＇ t find VRSA and VISA. But there was 3.11% of Enterococcus intermediate to vancomvcin. So we should pay more attention to it. Antimicrobial resistant coccus of pediatric has already become a serious problem in China. Ongoing surveillance study on the antimicrobial resistance of gram-positive coccus is necessai7 for appropriate antimicrobial use in pediatric clinical work.
出处
《首都医科大学学报》
CAS
2008年第5期626-631,共6页
Journal of Capital Medical University
基金
国家“十五”科技攻关课题(2004BA720A09-01)资助项目~~
关键词
革兰阳性球菌
儿科
耐药
Gram-positive eoccus： pediatric
drug resistance
