摘要
目的流感嗜血杆菌作为一种条件致病菌,可引起原发性及继发性感染,给临床治疗造成困难。本研究动态监测临床流感嗜血杆菌的耐药性及标本分布,为临床治疗流感嗜血杆菌引发的感染提供依据。方法收集泰安市中心医院2016-01-01-2016-12-31临床分离299株和2017-01-01-2017-12-31分离的368株流感嗜血杆菌,采用纸片扩散法检测流感嗜血杆菌对临床常用的12种抗菌药物敏感性,头孢硝噻吩纸片法检测β内酰胺酶。采用WHONET 5.6分别对抗菌药物耐药率及分布进行分析。结果2016年,流感嗜血杆菌对复方新诺明、氨苄西林、四环素、头孢呋辛、阿莫西林/克拉维酸、氨苄西林/舒巴坦、氯霉素和阿奇霉素的耐药率分别为80.94%、53.85%、24.75%、19.40%、3.34%、14.05%、7.69%和3.68%;2017年分别为77.45%、59.78%、27.17%、30.98%、10.60%、23.10%、5.43%和3.80%。2016和2017年度分离的流感嗜血杆菌对头孢呋辛(χ2=11.56,P=0.001)、阿莫西林/克拉维酸(χ2=12.751,P<0.001)和氨苄西林/舒巴坦(χ2=8.767,P=0.003)的耐药率,差异均有统计学意义;对其余9种抗菌药物的耐药率,差异均无统计学意义,均P>0.05。对左氧氟沙星、头孢噻肟、美罗培南和亚胺培南都敏感。2016年,β内酰胺酶阳性菌株占比为51.84%(155/299),2017年为57.61%(212/368),差异无统计学意义,χ2=2.219,P=0.136。氨苄西林耐药但β内酰胺酶阴性菌株占比2.10%(14/667)。44.53%(297/667)的标本分布在儿内科病房,96.40%(643/667)的标本来源于痰液。感染呈季节性分布,以春季和冬季为感染高发期。儿童(0~14周岁)检出率最高,为48.13%;其次为老年患者,检出率为30.13%。结论流感嗜血杆菌主要引起呼吸道感染,儿童感染率最高。应注意病原菌的耐药率变迁,合理用药以提高临床疗效。
OBJECTIVE Haemophilus influenzaeas is one kind of conditional pathogen bacteria,which could cause primary and secondary infection and give rise to difficulties in clinical treatment.This research dynamically monitors the drug resistance and distribution of Haemophilusinfluenzaand provides clinical evidence and experiences to the treatment for infections caused by Haemophilus influenza.METHODS Totally 299 and 368 clinically isolated Haemophilus influenzae strains were collected from the year of 2016 and 2017 respectively at Taian City Central Hospital.Disk diffusion method was adopted to detect the collected strains’sensitivity to 12 kinds of the most clinically used antimicrobials.β-lactamase was detected by Nitrocefin-disk test.The distribution of the collected strains and its drug resistance rates to antimicrobials were analyzed by WHONET 5.6 software.RESULTS The drug resistance rates of Haemophilus influenzato sulfamethoxazole,ampicillin,tetracycline,cefuroxime,amoxicillin/clavulanic acid,ampicillin/sulbactam,chloramphenicol and azithromycin were 80.94%,53.85%,24.75%,19.40%,3.34%,14.05%,7.69%,3.68%in 2016 and 77.45%,59.78%,27.17%,30.98%,10.60%,23.10%,5.43%,3.80%in 2017.The drug resistance rates differences between2016 and 2017 of Haemophilus influenzato cefuroxime(χ2=11.56,P=0.001),amoxicillin/clavulanic acid(χ2=12.751,P<0.001)and ampicillin/sulbactam(χ2=8.767,P=0.003)were of statistical significance,whereas the drug resistance rates differences presented on the other 9 antimicrobials were not statistically substantial.All the collected strains were sensitive to levofloxacin,cefotaxime,meropenem and imipenem.51.84%(155/299)of the strains were tested to beβ-lactamase positive in 2016 and 57.61%(212/368)in 2017,which showed no statistical meaning(χ2=2.219,P=0.136).The stains with ampicillin-resistant and beta-lactamase-negative accounted for 2.10%(14/667).44.53%(297/667)of the specimens were found to be distributed in pediatric wards and 96.40%(643/667)were detected from sputum specimens.The infections were distributed seasonally,and concentrated in spring and winter.Children(0-14 years old)patients hold the highest detection rate(48.13%),and followed by the elderly patients.CONCLUSIONS Haemophilus influenzae mainly causes respiratory infections,and children are the most susceptible group.Special attention should be given to the variation in the drug resistance of pathogenic bacteria so as to improve clinical efficacy.
作者
朱刚
张志军
魏绪廷
姜梅杰
ZHU Gang;ZHANG Zhi-jun;WEI Xu-ting;JIANG Mei-jie(General Surgery Department of Taishan District People's Hospital,Taian271000,P.R.China;Taian Central Hospital,Taian271000,P.R.China)
出处
《社区医学杂志》
2020年第7期469-472,共4页
Journal Of Community Medicine
关键词
流感嗜血杆菌
不同时间
耐药性
标本分布
Haemophilus influenzae
different time
drug resistance
specimen distribution
作者简介
第一作者:朱刚,男,山东泰安人,主治医师,主要从事外科术后感染相关的研究工作。Tel:86-538-8273435,E-mail:37900883@qq.com;通信作者:姜梅杰,女,辽宁大连人,主任技师,主要从事细菌耐药机制与流行病学的研究工作。Tel:86-538-6296578,E-mail:xtingw@126.com
