中国儿童肺炎链球菌抗菌药物耐药性的流行情况：四家医院的监测

Prevalence of antimicrobial resistance of Streptococcus pneumoniae in Chinese children: four hospitals surveillance.

作者信息

Shen Xuzhuang, Lu Quan, Ye Qici, Zhang Guocheng, Yu Sangjie, Zhang Hong, Deng Qiulian, Yang Yonghong

机构信息

Beijing Children's Hospital, Beijing 100045, China.

出版信息

Chin Med J (Engl). 2003 Sep;116(9):1304-7.

PMID:14527353

Abstract

OBJECTIVE

To investigate the nasal carriage of antibiotic-resistant pneumococci in children of < 5 years old in the following four cities, Beijing, Shanghai, Guangzhou and Xi'an.

METHODS

A total of 647 pneumococci strains were isolated and detected. Minimal inhibition concentrations (MICs) of antibiotics were determined by E-test. Disk diffusion test was used for the measurement of antimicrobial susceptibility.

RESULTS

Prevalence of penicillin non-susceptible Streptococcus pneumoniae in the four cities was 41%, with Guangzhou (60.8%) ranking first, followed by Xi'an (45%), Shanghai (37%) and Beijing (25.9%). The majority of penicillin non-susceptibility isolates (23.9% - 53.8%) had a low level of resistance (MIC 0.64 - 1.5 microg/ml). The most sensitive antimicrobials in terms of percentage of susceptible organisms were amoxicillin-clavulanic acid (99.4%), followed by ceftriaxone (92.1%); cefurxime and cefaclor were slightly more sensitive than penicillin with susceptibility of 74.8% and 77.9%. Erythromycin, tetracycline and TMP-SMZ were highly resistant (83.6%, 82.1% and 76.2% respectively). Among erythromycin resistant isolates, 100% were resistant to azithromycin, 98.6% to clarithromycin, 97.2% to roxithromycin and spiramycin, and 96.6% to clindamycin. 97.2% (141/145) were typical of the macrolides-lincosamides-streptogramons B (MLSB) resistance phenotype, and 2.8% (4/145) were M phenotype. The group of PRSP was with significantly higher rates of non-susceptibility for ceftriaxone (18.4%), cefurxime (58.6%), cefaclor (53.4%), compared with the group of PEN-S (0.5%, 1.8% and 0.2%, respectively) and the rate of multi-drug resistance in the isolates of PRSP group (92.9%) was significantly higher than that of PEN-S group (59.2%).

CONCLUSION

The rates of penicillin and multi-drug resistance among isolates of pneumococci carried nasally in are high children and the high prevalence of multi-drug resistance in the Chinese population may be becoming one of the most serious problems in this century.

摘要

目的

调查北京、上海、广州和西安四个城市5岁以下儿童鼻腔中耐抗生素肺炎球菌的携带情况。

方法

共分离并检测647株肺炎球菌菌株。采用E-test法测定抗生素的最低抑菌浓度（MICs）。采用纸片扩散法测定抗菌药物敏感性。

结果

四个城市中青霉素不敏感肺炎链球菌的患病率为41%，其中广州（60.8%）居首，其次是西安（45%）、上海（37%）和北京（25.9%）。大多数青霉素不敏感分离株（23.9% - 53.8%）耐药水平较低（MIC为0.64 - 1.5微克/毫升）。就敏感菌百分比而言，最敏感的抗菌药物是阿莫西林-克拉维酸（99.4%），其次是头孢曲松（92.1%）；头孢呋辛和头孢克洛比青霉素稍敏感，敏感性分别为74.8%和77.9%。红霉素、四环素和复方磺胺甲恶唑耐药性高（分别为83.6%、82.1%和76.2%）。在红霉素耐药分离株中，100%对阿奇霉素耐药，98.6%对克拉霉素耐药，97.2%对罗红霉素和螺旋霉素耐药，96.6%对克林霉素耐药。97.2%（141/145）为大环内酯类-林可酰胺类-链阳菌素B（MLSB）耐药表型，2.8%（4/145）为M表型。与青霉素敏感组（PEN-S，分别为0.5%、1.8%和0.2%）相比，青霉素不敏感肺炎链球菌组对头孢曲松（18.4%）、头孢呋辛（58.6%）、头孢克洛（53.4%）的不敏感率显著更高，且青霉素不敏感肺炎链球菌组分离株的多重耐药率（92.9%）显著高于青霉素敏感组（59.2%）。