摘要
目的 调查2012年我国11家医院成人社区获得性呼吸道感染病原菌的耐药性.方法 收集2012年1-12月全国11家中心分离的599株成人社区获得性呼吸道感染病原菌,其中肺炎链球菌381株,流感嗜血杆菌137株,卡他莫拉菌81株.采用琼脂稀释法测定抗菌药物的MIC值.结果 50％（300/599）的菌株分离自60岁以上的患者,16.2％（97/599）的菌株分离自40岁以下的患者.按照肺炎链球菌口服青霉素的折点判定标准,56.7％（216/381）的肺炎链球菌为青霉素不敏感菌株（PNSSP）,肺炎链球菌对大环内酯类的耐药率超过90％（345/381）,对口服头孢菌素的耐药率为39.9％ ～50.7％（152 ～ 193株）.肺炎链球菌对左氧氟沙星和莫西沙星的敏感度分别为97.8％（372/381）和99％（377/381）.PNSSP对头孢曲松、阿莫西林/克拉维酸、头孢克洛、头孢呋辛的耐药率显著高于青霉素敏感菌株（PSSP）.流感嗜血杆菌对除氨苄西林（71.5％,272/381）和头孢克洛（75.2％,286/381）外的抗菌药物的敏感度均超过90％.流感嗜血杆菌中β-内酰胺酶阳性率为21.9％（30/137）,且β-内酰胺酶阳性菌株对氨苄西林、头孢克洛、氯霉素和四环素的耐药性显著高于β-内酰胺酶阴性菌株.氟喹诺酮类药物对流感嗜血杆菌的作用效果明显.除克林霉素、阿奇霉素和克拉霉素对卡他莫拉菌作用较差外,其他药物对卡他莫拉菌均具有较高的抗菌活性.结论 大环内酯类和口服头孢菌素类药物对肺炎链球菌、流感嗜血杆菌和卡他莫拉菌的抗菌活性有限,左氧氟沙星和莫西沙星对肺炎链球菌、流感嗜血杆菌和卡他莫拉菌仍具有较高的抗菌活性.
Objective To investigate antimicrobial resistance among pathogens responsible for adult community-acquired respiratory tract infections from 11 hospitals of China.Methods From January to December 2012,a total of 599 strains causing adult community-acquired respiratory tract infection were collected from 11 hospitals,including 381 Streptococcus pneumonia,137 Haemophilus influenza,and 81 Moraxella catarrhalis.The minimal inhibitory concentration （MIC） of antibacterial agents was determined by agar dilution method.Results Of all the strains,50％ （300/599 strains） were from adults more than 60 years old and only 16.2％ （97/599 strains） were from patients aged less than 40 years.According to oral penicillin breakpoints,56.7％ （216/381 strains） of Streptococcus pneumoniae were penicillin nonsusceptible strains （PNSSP）.More than 90％ （345/381 strains） and 39.9％ （152/381 strains）-50.7％ （193/381 strains） of Streptococcus pneumoniae were resistant to macrolides and oral cephalosporins respectively,but over 97.8％ （372/381 strains） and 99％ （377/381 strains） were susceptible to levofloxacin and moxifloxacin.PNSSP strains exhibited significant higher resistance to ceftriaxone,amoxicillin/clavulanate,cefaclor and cefuroxime compared with penicillin susceptible Streptococcus pneumoniae （PSSP）.The susceptibility rates of Haemophilus influenza to the antimicrobial agents were over 90％ except for ampicillin （71.5％,272/381 strains） and cefaclor （75.2％,286/381 strains）.The prevalence of β-lactamase positive Haemophilus influenza were 21.9％ （30/137 strains）,and β-lactamase positive Haemophilus influenza strains were more resistant to ampicillin,cefaclor,chloramphenicol and tetracycline compared with β-1actamase-negative strains.Moraxella catarrhalis strains were extremely susceptible to all the antimicrobial agents tested except for clindamycin,azithromycin and clarithromycin.Conclusions The activities of macrolides and oral cephalosporins against Streptococcus pneumoniae,Haemophilus influenzae and Moraxella catarrhalis were limited.Levofloxacin and moxifloxacin exhibited good activities against Streptococcus pneumoniae,Haemophilus influenzae and Moraxella catarrhalis.
出处
《中华结核和呼吸杂志》
CAS
CSCD
北大核心
2015年第1期18-22,共5页
Chinese Journal of Tuberculosis and Respiratory Diseases
关键词
呼吸道感染
社区获得性感染
链球菌
肺炎
抗药性
Respiratory tract infections
Community-acquired infections
Streptococcus pneumoniae
Drug resistance
