Ge L L, Han Z Y, Liu A H, Zhu L, Meng J H
Department of Respiratory Medicine, Shanxi Children's Hospital, Taiyuan 030000, China.
Zhonghua Er Ke Za Zhi. 2017 Feb 2;55(2):109-114. doi: 10.3760/cma.j.issn.0578-1310.2017.02.011.
To investigate the antibiotic resistance status of Streptococcus pneumoniae isolates from hospitalized children in Shanxi Children's Hospital. E-test and Kirby-Bauer methods were applied to determine drug sensitivity of the isolates collected from the body fluid specimens of hospitalized children in Shanxi Children's Hospital from January 2012 to December 2014. The antimicrobial sensitivity and minimum inhibitory concentration (MIC) of Streptococcus pneumoniae to the conventional antibiotics were analyzed, in order to compare the annual trends of non-invasive isolates, while the differentiation of sensitivity from specimens. The comparison of rates was performed by Chi-squared test and Fisher's exact test. A total of 671 isolates of streptococcus pneumoniae were obtained, which could be divided as non-invasive isolates(607), invasive isolates from non-cerebrospinal fluid(non-CSF)(40) and invasive isolates from cerebrospinal fluid(CSF)(24). The antimicrobial sensitivity(isolates(%)) of the 671 isolates were respectively vancomycin 671(100.0%), linezolid 671(100.0%), levofloxacin 665(99.1%), penicillin 595(88.7%), ceftriaxone 516(76.9%), cefotaxime 512(76.3%), sulfamethoxazole-trimethoprin(SMZ-TMP) 103(15.4%), clindamycin 28(4.2%), tetracycline 26(3.9%), erythromycin 12(1.8%). From 2012 to 2014, the susceptibility rates of non-invasive isolates to penicillin every year were 95.0%(96/101), 97.3%(110/113), 87.3%(343/393), respectively, and there was significant difference among the three years(χ(2)=13.266, <0.05), and the values of MIC(50, )MIC(90) and the maximum values of MIC(mg/L) of penicillin were 0.064, 2.000, 6.000 in 2012, which grew up to 1.000, 3.000, 16.000 in 2014. There was no significant difference in the susceptibility rate of non-invasive isolates to ceftriaxone and cefotaxime during these three years, (χ(2)=1.172, 1.198, both >0.05). On the other hand, the values of MIC(50, )MIC(90) and the maximum value of MIC(mg/L) of ceftriaxone and cefotaxime both increased from 0.500, 2.000, 8.000 in 2012 to 0.750, 4.000, 32.000 in 2014. There was no significant difference in the susceptibility rate of non-invasive isolates to the rest antibiotic. Based on the same examining standard of CSF, the antimicrobial sensitivity(isolates(%)) of the non-invasive isolates to ceftriaxone, cefotaxime, SMZ-TMP were respectively 281(46.3%), 278(45.8%), 78(12.9%), were significantly lower than the susceptibility rate of the invasive isolates from non-CSF (28(70%), 28(70%), 14(35%), χ(2)=8.453, 8.817, 15.094, all <0.012 5), and lower than the invasive isolates from CSF (18(75%), 18(75%), χ(2)=7.631, 7.905, <0.012 5; 11(45.8%), =0.001). The sensitivity of the isolates to the rest antibiotics were similar(>0.05). More than 95.0% strains of the streptococcus pneumoniae isolates from the hospitalized children in Shanxi Children's Hospital were sensitive to vancomycin, linezolid, levofloxacin, and the susceptibility rate of penicillin, ceftriaxone, cefotaxime were 88.7%, 76.9%, 76.3%. However, less than 20.0% of streptococcus pneumoniae were sensitive to erythromycin, clindamycin, SMZ-TMP and tetracycline. The susceptibility rate of penicillin of non-invasive Streptococcus pneumoniae declined by these years, and the differences to ceftriaxone and cefotaxime can be neglected, but the values of MIC(50, )MIC(90) and the maximum value of MIC of all were linearly rising. The susceptibility rate of antibiotics to ceftriaxone and cefotaxime of the non-invasive isolates was lower than the invasive isolates.
为调查山西儿童医院住院儿童肺炎链球菌分离株的耐药状况。采用E试验和纸片扩散法对2012年1月至2014年12月期间山西儿童医院住院儿童体液标本中分离出的菌株进行药敏测定。分析肺炎链球菌对常规抗生素的药敏情况及最低抑菌浓度(MIC),比较非侵袭性分离株的年度变化趋势及不同标本的药敏差异。率的比较采用卡方检验和Fisher确切概率法。共获得671株肺炎链球菌分离株,分为非侵袭性分离株(607株)、非脑脊液侵袭性分离株(40株)和脑脊液侵袭性分离株(24株)。671株分离株对各抗菌药物的敏感率(菌株数(%))分别为:万古霉素671(100.0%)、利奈唑胺671(100.0%)、左氧氟沙星665(99.1%)、青霉素595(88.7%)、头孢曲松516(76.9%)、头孢噻肟512(76.3%)、复方磺胺甲恶唑(SMZ-TMP)103(15.4%)、克林霉素28(4.2%)、四环素26(3.9%)、红霉素12(1.8%)。2012 - 2014年,非侵袭性分离株每年对青霉素的敏感率分别为95.0%(96/101)、97.3%(110/113)、87.3%(343/393),三年间差异有统计学意义(χ² = 13.266,P < 0.05),2012年青霉素的MIC(50)、MIC(90)及MIC最大值(mg/L)分别为0.064、2.000、6.000,2014年增长至1.000、3.000、16.000。这三年非侵袭性分离株对头孢曲松和头孢噻肟的敏感率差异无统计学意义(χ² = 1.172、1.198,P均>0.05)。而头孢曲松和头孢噻肟的MIC(50)、MIC(90)及MIC最大值均从2012年的0.500、2.000、8.000增长至2014年的0.750、4.000、32.000。非侵袭性分离株对其余抗生素的敏感率差异无统计学意义。按照相同的脑脊液检测标准,非侵袭性分离株对头孢曲松、头孢噻肟、SMZ-TMP的敏感率(菌株数(%))分别为281(46.3%)、278(45.8%)、78(12.9%),显著低于非脑脊液侵袭性分离株(28(70%)、28(70%)、14(35%),χ² = 8.453、8.817、15.094,P均<0.012 5),且低于脑脊液侵袭性分离株(18(75%)、18(75%),χ² = 7.631、7.905,P < 0.012 5;11(45.8%),P = 0.001)。分离株对其余抗生素的敏感性相似(P>0.05)。山西儿童医院住院儿童肺炎链球菌分离株中,超过95.0%的菌株对万古霉素、利奈唑胺、左氧氟沙星敏感,青霉素、头孢曲松、头孢噻肟的敏感率分别为88.7%、76.9%、76.3%。然而,对红霉素、克林霉素、SMZ-TMP和四环素敏感的肺炎链球菌不足20.0%。近年来非侵袭性肺炎链球菌对青霉素的敏感率下降,对头孢曲松和头孢噻肟的差异可忽略,但MIC(50)、MIC(90)及MIC最大值均呈线性上升。非侵袭性分离株对头孢曲松和头孢噻肟的药敏率低于侵袭性分离株。