2005—2014年CHINET流感嗜血杆菌和卡他莫拉菌耐药性监测

发布时间：2018-08-02 20:57

【摘要】：目的了解2005—2014年国内不同地区临床分离流感嗜血杆菌和卡他莫拉菌的耐药性变迁。方法收集17所综合性医院和2所儿童医院临床分离的7 983株流感嗜血杆菌和1 713株卡他莫拉菌,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,依照CLSI 2014版标准判断结果。头孢硝噻吩纸片法测定β内酰胺酶。结果 10年间,流感嗜血杆菌的检出率呈上升趋势:2005年为0.69%,2014年上升至1.57%;10年间,卡他莫拉菌的检出率呈上升趋势:2005年为0.03%,2014年上升至0.41%。7 983株流感嗜血杆菌对甲氧苄啶-磺胺甲唑耐药率最高且上升趋势最明显,由2005年的44.4%上升至2014年的64.6%;对氨苄西林、氨苄西林-舒巴坦和阿奇霉素耐药率呈上升趋势,分别由2005年的20.6%、11.8%和2.2%上升至2014年的41.8%、24.8%和14.2%;对头孢噻肟、环丙沙星和氯霉素耐药率近年有下降趋势;对阿莫西林-克拉维酸和头孢呋辛耐药率虽略有上升趋势,但仍低于25%。儿童分离株对氨苄西林的耐药率和产酶率(36.7%、33.8%)均高于成人分离株(25.7%、22.5%),对环丙沙星的耐药率(4.7%)低于成人分离株(15.8%),耐药率差异均有统计学意义(P0.05)。β内酰胺酶总检出率为29.9%。383株为β内酰胺酶阴性氨苄西林耐药株(BLNAR)。1 713株卡他莫拉菌对第二和第三代头孢菌素、阿莫西林-克拉维酸、左氧氟沙星和甲氧苄啶-磺胺甲唑均高度敏感(敏感率为80%~100%),耐药率变化较小,但对阿奇霉素的耐药率较高且呈上升趋势,由2006年的41.2%增至2013年的57.8%。该菌产β内酰胺酶的检出率为93.3%。结论流感嗜血杆菌对头孢菌素类、阿莫西林-克拉维酸、阿奇霉素、氯霉素及环丙沙星耐药率较低,可作为临床的首选用药,而对甲氧苄啶-磺胺甲唑耐药率已上升至60%左右,不适于临床用药。卡他莫拉菌对所测试药物耐药率变化较小。
[Abstract]:Objective to investigate the changes of drug resistance of Haemophilus influenzae and Haemophilus Casamora in different regions of China from 2005 to 2014. Methods A total of 7 983 strains of Haemophilus influenzae and 1 713 strains of Mora carinii were collected from 17 general hospitals and 2 children's hospitals. Judge the results according to CLSI version 2014 standard. Determination of 尾-lactamase by ceftathiophene disk method. Results the detection rate of Haemophilus influenzae increased in 10 years: 0.69 in 2005 and 1.57 in 2014. The positive rate of Haemophilus influenzae increased from 0.03% in 2005 to 0.417.983 strains of Haemophilus influenzae in 2014, and the highest and most obvious trend was observed, from 44.4% in 2005 to 64.6% in 2014. The resistance rates of ampicillin-sulbactam and azithromycin increased from 20. 6% and 2. 2% in 2005 to 41. 8% and 14. 2% in 2014, respectively, and the resistance rates to cefotaxime, ciprofloxacin and chloramphenicol decreased in recent years. The rates of resistance to amoxicillin-clavulanic acid and cefuroxime were slightly increased, but still lower than 25%. The rate of resistance to ampicillin and enzyme production in children (36.733.8%) was higher than that in adults (25.722.5%), and the resistance to ciprofloxacin (4.7%) was lower than that to ciprofloxacin (15.8%). The difference was significant (P0.05). The total detection rate of 尾 lactamases was 29.99.383 strains. The second and third generation cephalosporins were isolated from 尾 -lactamase-negative ampicillin resistant strain (BLNAR) 1.713. Amoxicillin clavulanic acid, levofloxacin and trimethoprim sulfamethazolium were highly sensitive (the sensitivity rate was 80%), the drug resistance rate changed slightly, but the resistance to azithromycin increased from 41.2% in 2006 to 57.8% in 2013. The positive rate of 尾-lactamase production was 93. 3%. Conclusion the resistance rate of Haemophilus influenzae to cephalosporins, amoxicillin-clavulanic acid, azithromycin, chloramphenicol and ciprofloxacin is low and can be used as the first choice for clinical use, while the resistance rate to trimethoprim-sulfamethazole has increased to about 60%. Not suitable for clinical use. There was little change in drug resistance of Mora katamurium to the tested drug.
【作者单位】：上海市儿童医院上海交通大学附属儿童医院;复旦大学附属儿科医院;北京协和医院;广州医科大学第一附属医院;北京医院;华中科技大学同济医学院附属同济医院;四川大学华西医院;甘肃省人民医院;昆明医科大学第一附属医院;浙江大学医学院附属邵逸夫医院;安徽医科大学第一附属医院;内蒙古医科大学附属医院;浙江大学附属第一医院;重庆医科大学附属第一医院;上海交通大学医学院附属瑞金医院;新疆医科大学第一附属医院;中国医科大学附属第一医院;天津医科大学总医院;复旦大学附属华山医院;
【分类号】：R446.5

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