2012至2015年昆明医科大学第一附属医院流感嗜血杆菌耐药性监测
Surveillance of Antimicrobial Resistance of Haemophilus influenzae in First Affiliated Hospital of Kunming Medical University during 2012 and 2015
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摘要: 目的 了解昆明医科大学第一附属医院临床分离的流感嗜血杆菌对常用抗菌药物的耐药情况, 为临床合理使用抗生素提供依据.方法 收集2012年1月至2015年12月184株临床分离的流感嗜血杆菌, 采用纸片扩散法 (K-B法) 进行抗菌药物敏感性试验, Nitrocefin纸片检测定β-内酰胺酶, 用WHONET5.6软件对流感嗜血杆菌耐药率进行统计分析.结果 184株临床分离的流感嗜血杆菌对氨苄西林耐药率最高, 达46.7%, 其次对氯霉素、氨苄西林/舒巴坦耐药率分别为23.2%、13%.该菌对阿奇霉素、环丙沙星、美洛培南、头孢呋辛、头孢噻肟的耐药率均在10%以下.儿童分离株对氨苄西林的耐药率 (56.9%) 高于成人分离株 (42.1%) ;除环丙沙星、美洛培南和氯霉素外, 儿童株对其他测试抗菌药物的耐药率均较成人株高.产β-内酰胺酶株总检出率为52.8%, 其中儿童分离株产酶检出率为64.3%高于成人分离株产酶检出率47.6%.共检出氨苄西林耐药而β-内酰胺酶阴性菌株1株, 占0.5%.结论 流感嗜血杆菌主要分离自住院患者呼吸道分泌物标本.虽然该菌对头孢菌素类、大环内酯类、酶抑制剂复方制剂、喹诺酮类、碳青霉烯酶类抗菌药物保持良好的抗菌活性, 但是产β内酰胺酶仍是流感嗜血杆菌的重要耐药机制, 表现为氨苄西林耐药率较高, 因此不建议作为流感嗜血杆菌感染的经验性治疗.Abstract: Objective To investigate the antibiotic resistance of clinical strains of Haemophilus in fluenzae (HI) isolated from the First Affiliated Hospital of Kunming Medical University, to provide scientific data for using antibiotic in clinic rationally. Methods Clinical strains of HI were collected from January2012 to December 2015, Kirby-Bauer method was used to antimicrobial susceptibility test, beta-lactamases were detected by nitrocefin disk test. Data from antibiotic resistance of HI were analyzed by WHONET5.6. Results Among the 184 clinical strains of HI, the resistance rate to ampicillin, chloramphenicol, ampicillin\sulbactam was 46.7%, 23.2%, 13%, respectively. About 90% of these HI strains were still susceptible to azithromvcin, ciprofloxacin, meropenem, cefuroxime, cefotaxime. The resistance rate to ampicillin in the HI strains from children (56.9%) were higher than in the strains from adults (42.1%) , the resistance rate to ciprofloxacin, chloramphenicol, meropenem was in HI strains from children, significantly higher than in the strains from adults. The overall prevalence of beta-lactamases was 52.8% in the HI strains. The prevalence of beta-lactamases (64.3%) in the strains from children was higher than the prevalence of beta-lactamases (47.6%) in the strains from adults. There are one HIstrain resistant to ampicillin but beta-lactamases negative. Conclusions HI was mainly isolated from respiratory specimen and hospitalized patients. Ampicillin is inapplicable to empiric treatment for HI. Cephalosporin antibiotic, macrolides, enzyme inhibitor, quinlone, carbapenemases are stably susceptible. Beta-lactamase is the important mechanism of resistance.
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Key words:
- Haemophilus influenzae /
- Kirby-Bauer method /
- Beta-lactamases /
- Drug resistance
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