摘要
目的 调查2009-2010年我国成人社区获得性呼吸道感染病原菌的耐药性.方法 收集2009-2010年全国6城市11家医院分离的1793株非重复社区获得性呼吸道感染病原菌,其中金黄色葡萄球菌421株,肺炎链球菌420株,肺炎克雷伯杆菌404株,流感嗜血杆菌313株,β-溶血性链球菌属149株,卡他莫拉菌86株；采用微量肉汤稀释法测定抗菌药物的MIC值；利用头孢硝噻吩试验测定β-内酰胺酶的产生情况.结果 所有金黄色葡萄球菌均为甲氧西林敏感的金黄色葡萄球菌（MSSA）.MSSA对头孢菌素类及加酶抑制剂的耐药率均＜1％ （4/421）,对左氧氟沙星和莫西沙星的耐药率分别为13.1％ （55/421）和9％（38/421）,对阿奇霉素和克拉霉素的耐药率分别为57％（240/421）和53.2％（224/421）,对青霉素的耐药率为88.7％（ 373/421）,未发现万古霉素耐药的金黄色葡萄球菌.口服青霉素耐药的肺炎链球菌（PRSP）、青霉素中介耐药的肺炎链球菌（PISP）和青霉素敏感的肺炎链球菌（PSSP）所占的比例分别为24.4％（ 102/420）、27.3％ （115/420）和48.3％（203/420）,注射用青霉素为1.9％ （8/420）、9％（38/420）和89.1％ （374/420）；PRSP对多数抗菌药物的耐药率明显高于PISP和PSSP;肺炎链球菌对阿奇霉素和克拉霉素的耐药率分别为88.2％（370/420）和87.4％（367/420）；对头孢克罗、头孢呋辛、头孢曲松和阿莫西林/克拉维酸的耐药率分别为45.3％（190/420）、41.9％（176/420）、10.2％（43/420）和5.2％（ 22/420）,对左氧氟沙星和莫西沙星的耐药率分别为2.6％ （11/420）和0.2％ （1/420）.β-溶血性链球菌对阿奇霉素和克拉霉素的耐药率＞ 70％ （104/149）,对左氧氟沙星的耐药率为10.1％（15/149）.肺炎克雷伯杆菌对大部分抗菌药物的耐药率＞20％ （81/404）,对头孢他啶的耐药率低于头孢呋辛、头孢克罗及头孢曲松.超广谱β-内酰胺酶（ESBL）的阳性率平均为38.8％ （157/404）,且存在较大地区差异.流感嗜血杆菌和卡他莫拉菌对多数抗菌药物敏感,耐药率＜5％（流感嗜血杆菌16/313,卡他莫拉菌4/86）；此外,13.1％（41/313）的流感嗜血杆菌和91.7％（79/86）的卡他莫拉菌产β-内酰胺酶.结论 PRSP所占比例明显增高,常规用药如大环内酯类及头孢菌素类的敏感性逐渐降低,莫西沙星对大多数呼吸道病原菌仍保持较高的抗菌活性.
Objective To investigate the drug-resistance rates of community-acquired respiratory tract pathogens isolated from adults in China during 2009 and 2010.Methods A total of 1793 strains （ S.aureus 421,S.pneumoniae 420,K.pneumoniae 404,H. influenzae 313,other Streptococcus. spp 149,and M.catarrhalis 86） of non-duplicated community-acquired respiratory tract pathogens were isolated from 11 hospitals in 6 cities.The MIC values were determined by the broth microdilution method,and the production of β-lactamase was tested using a nitrocefin-based test.Results All of the S.aureus isolates were methicillin-sensitive （MSSA）.Of the MSSA isolates,less than 1% （4/421） was resistant to β-lactamase inhibitor combinations, about 13.1% （55/421） and 9% （38/421） resistant to levofloxacin and moxifloxacin,and 57% （240/421）,53.2% （224/421）,and 88.7% （ 373/421 ） resistant to azithromycin,clarithromycin,and penicillin,respectively.No S.aureus isolates resistant to vancomycin were detected in this study. Based on different criteria,the percentages of penicillin-sensitive S. pneumoniae （PSSP）,penicillin-intermediate S. pneumoniae （PISP）,and penicillin-resistant S. pneumoniae （PRSP） were 24.4% （ 102/420）,27.3% （115/420）,48.3% （203/420） （Oral） and 1.9% （8/420）,9% （38/420）,89.1% （ 374/420 ） （ parenteral ）,respectively. The resistance rates of S.pneumonia to azithromycin,clarithromycin,cefaclor,cefuroxime,ceftriaxone and amoxicillin with clavulanic acid were 88.2% （370/420）,87.4% （367/420）,45.3% （ 190/420）,41.9% （ 176/420）,10.2% （43/420）,and 5.2% （22/420）,respectively.About 2.6% （11/420） and 0.2% （1/420） of S.pneumonia isolates were resistant to levofloxacin and moxifloxacin.More than 70% （ 104/149 ） of β-hemelutic streptococci isolates were resistant to azithromycin and clarithromycin, and about 10.1% （15/149） of isolates were resistant to levofloxacin.The resistance rates of K.pneumonia to most antibiotics were 〉 20% （81/404）,and that of ceftazidime was lower than cefuroxime,cefaclor,and ceftriaxone. The mean prevalence value of ESBL producing K.pneumonia was 38.8% （ 157/404 ）,with significantly regional variations. More than 90% of H.influenza and M.catarrhalis were susceptible to most antibiotics,with resistance rate of 〈 5 % （16/313,H. influenza; 4/86, M. catarrhalis ）. The mean productions of β-lactamase in H. influenza and M.catarrhalis were 13.1% （41/313） and 91.7% （79/86）,respectively.Conclusions The percentage of PRSP increased significantly,and the resistance rates of community-acquired respiratory tract pathogens to common antibiotics such as macrolide and cephalosporins increased gradually.New fluoroquinolones such as moxifloxacin showed a high antimicrobial activity against most of the respiratory pathogens.
出处
《中华结核和呼吸杂志》
CAS
CSCD
北大核心
2012年第2期113-119,共7页
Chinese Journal of Tuberculosis and Respiratory Diseases
关键词
呼吸道感染
细菌感染
抗菌药
抗药性
Respiratory tract infection
Bacterial infection
Anti-bacterial agents
Drug resistance
