摘要
目的了解儿童呼吸道感染流感嗜血杆菌(HI)的耐药情况及合并感染多种病原体的特点。方法收集2018年6月—2019年5月在湖南省儿童医院检验中心检测的呼吸道感染患儿痰标本,分离培养病原体,分析HI及合并感染的病原体情况。使用全自动质谱仪鉴定细菌,采用免疫荧光法检测呼吸道病毒抗原,使用专用嗜血杆菌药敏板进行药敏试验及β-内酰胺酶检测,使用WHONET 5.5软件对菌株分布和药敏结果进行统计分析。结果36452份痰标本共检出HI 2974株(阳性率8.16%),其中552株(18.56%)同时合并感染其他病原菌,分别是:肺炎链球菌266株(占48.19%)、肠杆菌科菌112株(占20.29%)、金黄色葡萄球菌81株(占14.67%)、非发酵杆菌59株(占10.69%)、其他菌株34株(占6.16%);1093株(40.75%)同时合并呼吸道病毒感染,分别是:合胞病毒499株(占45.65%)、副流感病毒281株(占25.71%)、流感病毒229株(占20.95%)、腺病毒84株(占7.69%)。分离出的2708株HI对氨苄西林、复方新诺明、氨苄西林/舒巴坦的耐药率分别是67.91%、66.54%、64.84%,但对第三代头孢菌素、氟喹诺酮类和哌拉西林/他唑巴坦敏感率高,其中产β-内酰胺酶有1060株(占39.14%),且均对氨苄西林耐药;另外β-内酰胺酶阳性阿莫西林/克拉维酸耐药(BLPACR)型HI和β-内酰胺酶阴性氨苄西林耐药(BLNAR)型HI分别检出183株和779株。结论儿童呼吸道感染HI时常合并肺炎链球菌、合胞病毒、流感/副流感病毒感染;本地区HI产β-内酰胺酶阳性率高,是氨苄西林耐药的主要机制。
Objective To investigate the drug resistance of Haemophilus influenzae(HI)in children with respiratory tract infection and the characteristics complex infection of multiple pathogens.Methods Samples of sputum from children with respiratory tract infection were collected in laboratory center of Hunan Children’s Hospital from June 2018 to May 2019,all samples were cultured and isolated,and the pathogens of HI and complex infection were analyzed.The bacteria were identified by automatic mass spectrometer,the respiratory virus antigen was detected by immunofluorescence method,drug sensitivity test andβ-lactamase test were performed using special haemophilus drug sensitive plate,and the distribution of bacterial strains and the results of drug susceptibility were statistically analyzed by WHONET 5.5 software.Results A total of 2974 strains of HI were detected from 36452 sputum specimens(positive rate of 8.16%),among which 552 strains(18.56%)were infected with other pathogenic bacteria,including 266 strains of Streptococcus pneumoniae(accounted for 48.19%),112 strains of Enterobacteriaceae(accounted for 20.29%),81 strains of Staphylococcus aureus(accounted for 14.67%),59 strains of non-Fermentable bacteria(accounted for 10.69%)and 34 strains of other pathogens(accounted for 6.16%).There were 1093 strains(accounted for 40.75%)simultaneously infected with respiratory virus,including 499 strains of syncytial virus(45.65%),281 strains of parainfluenza virus(accounted for 25.71%),229 strains of influenza virus(accounted for 20.95%)and 84 strains of adenovirus(7.69%).The drug resistance rates of the isolated 2708 strains of HI were 66.54%for Sulfamethoxazole,67.91%for ampicillin,and 64.84%for ampicillin/sulbactan,respectively.But the 2708 strains were highly sensitive to the third-generation cephalosporins,fluoroquinolones and piperacillin/sulbactan,among which 1060 strains(39.14%)producedβ-lactamase and were resistant to ampicillin.In addition,183 strains ofβ-lactamase-positive amoxicillin-clavulanate-resistance(BLPACR)HI and 779 strains ofβ-lactamase-negative ampicillin resistance(BLNAR)HI were detected.Conclusions HI is often co-infective with Streptococcus pneumoniae,syncytial virus and influenza/parainfluenza virus in children with respiratory tract infection.The high positive rate ofβ-lactamase produced by HI in this region is the main mechanism of ampicillin resistance.
作者
胡琼
莫丽亚
李先斌
黄彩芝
刘健龙
Hu Qiong;Mo Liya;Li Xianbin;Huang Caizhi;Liu Jianlong(Labortory Center,Hunan Children's Hospital,Changsha 410007,Hunan,China)
出处
《实用检验医师杂志》
2019年第4期196-199,共4页
Chinese Journal of Clinical Pathologist
作者简介
通信作者:胡琼,Email:824743448@qq.com
