Sun Hongli, Chen Ling, Chen Xulin, Jia Xinlan, Li Nanyang, Liu Weihong, Tong Hui, Xiang Rong, Zhang Fang, Zhao Huaizhou, Zhang Jidong, Xu Yingchun
Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Department of Clinical Medicine, Beijing 100730, China.
Zhonghua Jie He He Hu Xi Za Zhi. 2016 Jan;39(1):30-7. doi: 10.3760/cma.j.issn.1001-0939.2016.01.009.
To investigate the drug-resistance rate of community-acquired respiratory tract pathogens isolated from class B hospitals in China during 2013 and 2014.
A total of 860 strains (S.pneumoniae 299, K. pneumoniae 221, H. influenzae 185, S. aureus 116, and M. catarrhalis 39) of non-duplicated community-acquired respiratory tract pathogens were isolated from 10 class B hospitals in 9 cities. The minimal inhibitory concentration (MIC) of antibacterial agents was determined by the broth microdilution method. The sensitive rates and MIC range of the antibiotics were analyzed by the WHONET-5.6 software.
Only 19.7%(59/299) S. pneumoniae was sensitive to oral penicillin. The sensitive rates of S. pneumoniae to second-generation cephalosporins(cefuroxime and cefaclor), amoxicillin with clavulanic acid, ceftriaxone, and macrolides (erythromycin, azithromycin and clarithromycin) were 25.6% (77/299), 33.4% (100/299), 63.5% (190/299), and 4.4% (13/299), respectively. About 93.5% (280/299)and 98.0% (293/299)of S. pneumoniae isolates were sensitive to levofloxacin and moxifloxacin.All of the K. pneumoniae isolates were sensitive to ertapenem and imipenem. The sensitive rates of K. pneumoniae to ceftriaxone, cefotaxime, ceftazidime, cefepime, and cefoxitin were about 85.0%, 93.2% (206/221), and 90.3% (200/221)of K. pneumoniae isolates were sensitive to levofloxacin and moxifloxacin.The mean prevalence of ESBL-producing K. pneumoniae was 8.1% (18/221). No S. aureus isolates resistant to vancomycin were detected in this study.The sensitive rates of S. aureus to levofloxacin, moxifloxacin, trimethoprim/sulfamethoxazole, and rifampin were 83.5% (97/116), 82.8% (96/116), 89.6% (104/116) and 83.5% (97/116), respectively. 37.4% (43/116) and 34.8% (40/116)of S. aureus isolates were sensitive to erythromycin and chloramphenicol.All of the H. influenzae and M. catarrhalis isolates were sensitive to amoxicillin with clavulanic acid, ceftriaxone, levofloxacin and moxifloxacin. The sensitive rates of H. influenza and M. catarrhalis to ampicillin, cefuroxime, cefaclor, erythromycin, azithromycin, and clarithromycin were from 80% to 100%.
Penicillins, second-generation cephalosporins (cefuroxime and cefaclor) and amoxicillin with clavulanic acid showed low antimicrobial activity to S. pneumoniae, but a higher sensitive rate to ceftriaxone. The macrolides exhibited a high activity against H. influenza and M. catarrhalis, but low antimicrobial activity against S. pneumoniae and S. aureus. The antimicrobial activity of fluoroquinolones such as levofloxacin and moxifloxacin against most of the respiratory pathogens was high.
调查2013年至2014年中国二级医院分离的社区获得性呼吸道病原体的耐药率。
从9个城市的10家二级医院分离出860株非重复的社区获得性呼吸道病原体(肺炎链球菌299株、肺炎克雷伯菌221株、流感嗜血杆菌185株、金黄色葡萄球菌116株、卡他莫拉菌39株)。采用肉汤微量稀释法测定抗菌药物的最低抑菌浓度(MIC)。使用WHONET-5.6软件分析抗生素的敏感率和MIC范围。
仅19.7%(59/299)的肺炎链球菌对口服青霉素敏感。肺炎链球菌对第二代头孢菌素(头孢呋辛和头孢克洛)、阿莫西林克拉维酸、头孢曲松和大环内酯类(红霉素、阿奇霉素和克拉霉素)的敏感率分别为25.6%(77/299)、33.4%(100/299)、63.5%(190/299)和4.4%(13/299)。约93.5%(280/299)和98.0%(293/299)的肺炎链球菌分离株对左氧氟沙星和莫西沙星敏感。所有肺炎克雷伯菌分离株对厄他培南和美罗培南敏感。肺炎克雷伯菌对头孢曲松、头孢噻肟、头孢他啶、头孢吡肟和头孢西丁的敏感率约为85.0%、93.2%(206/221),约90.3%(200/221)的肺炎克雷伯菌分离株对左氧氟沙星和莫西沙星敏感。产超广谱β-内酰胺酶(ESBL)的肺炎克雷伯菌的平均流行率为8.1%(18/221)。本研究未检测到对万古霉素耐药的金黄色葡萄球菌分离株。金黄色葡萄球菌对左氧氟沙星、莫西沙星、甲氧苄啶/磺胺甲恶唑和利福平的敏感率分别为83.5%(97/116)、82.8%(96/116)、89.6%(104/116)和83.5%(97/116)。37.4%(43/116)和34.8%(40/116)的金黄色葡萄球菌分离株对红霉素和氯霉素敏感。所有流感嗜血杆菌和卡他莫拉菌分离株对阿莫西林克拉维酸、头孢曲松、左氧氟沙星和莫西沙星敏感。流感嗜血杆菌和卡他莫拉菌对氨苄西林、头孢呋辛、头孢克洛、红霉素、阿奇霉素和克拉霉素的敏感率在80%至100%之间。
青霉素、第二代头孢菌素(头孢呋辛和头孢克洛)和阿莫西林克拉维酸对肺炎链球菌的抗菌活性较低,但对头孢曲松的敏感率较高。大环内酯类对流感嗜血杆菌和卡他莫拉菌具有较高活性,但对肺炎链球菌和金黄色葡萄球菌的抗菌活性较低。左氧氟沙星和莫西沙星等氟喹诺酮类对大多数呼吸道病原体的抗菌活性较高。