论文摘要

成都地区肺炎链球菌对抗菌药物的耐药性调查曾雪峰　吕晓菊　雷秉钧　俞汝佳　冯萍　高燕渝(四川大学华西医院 ,　成都 610 0 41)了解成都地区临床分离的肺炎链球菌的耐药性 ,为肺炎链球菌感染临床合理应用抗菌药物提供理论依据。采用二倍琼脂稀释法测定 11种抗菌药物对肺炎链球菌的最低抑菌浓度 (MIC)。结果 ,91 94%菌株对青霉素敏感 ,中度耐药为 8 0 6% ;88 71%菌株对SMZ/TMP敏感 ,中度耐药为 11 2 9% ;肺炎链球菌对头孢呋辛、头孢噻肟、头孢吡肟、氧氟沙星、司帕沙星、美洛培南、万古霉素敏感率为 10 0 % ;红霉素、克林霉素耐药率相…     

儿童感染肺炎链球菌的耐药性分析

目的了解儿童肺炎链球菌（SP）的感染情况和对儿科常用抗菌药物的耐药状况，为预防感染和合理使用抗菌药物提供参考依据。方法采集患儿的临床标本进行肺炎链球菌的分离、鉴定和药敏试验，并统计分析其结果。结果共检出290株肺炎链球菌，未发现有耐万古霉素和阿莫西林／棒酸的肺炎球菌，对青霉素的MIC为0．003—1．0mg／L，未检出青霉素高耐药菌株，青霉素不敏感肺炎链球菌（PNSSP）达18．3％（53／290），对复方新诺明、克林霉素、红霉素、四环素、氯霉素、头孢呋辛、头孢克洛、氧氟沙星、头孢曲松的耐药率分别为：60．0％，59．3％，53．8％，41．4％，19．0％，16．2％，13．4％，3．1％，1．4％。结论肺炎链球菌是呼吸道感染和中耳炎的重要病原菌。应加强病原菌的耐药性监测，合理、谨慎使用抗菌药物，有效进行抗感染治疗，延缓耐药菌株的出现和遏制耐药株菌的播散。     

20种抗菌药物对肺炎链球菌的体外抗菌活性研究

目的：评价莫西沙星等20种常用抗菌药物对临床分离的60株肺炎链球菌的体外抗菌活性。方法：采用微量肉汤稀释法测定20种抗菌药物对肺炎链球菌的最低抑菌浓度（MIC）。结果：60株肺炎链球菌中有青霉素敏感的肺炎链球菌（PSSP）42株（71．7％）,青霉素不敏感肺炎链球菌（PNSSP）18株（28．3％）;其中,青霉素耐药的肺炎链球菌（PRSP）有2株（3．3％）。对PSSP菌株,20种抗菌药物中敏感率较高的药物有头孢曲松、头孢噻肟、加替沙星、莫西沙星、左氧氟沙星、阿莫西林／克拉维酸,敏感率均为100％;耐药率较高的药物有红霉素、罗红霉素、克拉霉素、阿奇霉素,耐药率分别为83-3％,83-3％,74．7％,74．7％。对PNSSP菌株,敏感率较高的药物有阿莫西林／克拉维酸、莫西沙星、头孢噻肟、加替沙星、左氧氟沙星,敏感率分别为100％,100％,88．8％,94．4％,94．4％;耐药率较高的药物有红霉素、克拉霉素、阿奇霉素,耐药率均为66．7％。20种抗菌药物对60株肺炎链球菌的累积抑菌百分率曲线显示莫西沙星和阿莫西林／克拉维酸的抑菌能力最强。结论：肺炎链球菌对大环内酯类、复方新诺明、磷霉素等抗菌药物的耐药率较高,第三、四代氟喹诺酮类药物（左氧氟沙星、莫西沙星、加替沙星）和阿莫西林／克拉维酸及第三代头孢菌素中的头孢噻肟、头孢曲松等对肺炎链球菌（包括PNSSP）有很好的抗菌活性,提示其可作为高度耐药肺炎链球菌感染的首选药物。     

192株肺炎链球菌对新喹诺酮体外耐药性测定

目的:调查192株肺炎链球菌对青霉素、红霉素和环丙沙星等的耐药现状,并与新喹诺酮类进行比较.方法:根据美国国家临床实验室标准委员会(NCCLS)标准使用微量肉汤稀释法检测192株肺炎链球菌对青霉素、红霉素、克林霉素和喹诺酮类抗菌药物的最低抑菌浓度(MIC).结果:肺炎链球菌对青霉素的耐药率(中介率+耐药率)已达42.7%,对红霉素的耐药率为77.6%,克林霉素、白霉素、环丙沙星的耐药率分别为66.7%、65.6%、57.3%,新喹诺酮类抗菌药物对之有较好的抗菌活性,敏感率皆大于90%,与是否对青霉素、红霉素耐药无关.结论:在我国,肺炎链球菌对青霉素、红霉素的耐药率较高,新喹诺酮类抗生素有较好的抗菌活性.     

192株肺炎链球菌对新喹诺酮体外耐药性测定

目的调查192株肺炎链球菌对青霉素、红霉素和环丙沙星等的耐药现状,并与新喹诺酮类进行比较.方法根据美国国家临床实验室标准委员会(NCCLS)标准使用微量肉汤稀释法检测192株肺炎链球菌对青霉素、红霉素、克林霉素和喹诺酮类抗菌药物的最低抑菌浓度(MIC).结果肺炎链球菌对青霉素的耐药率(中介率+耐药率)已达42.7%,对红霉素的耐药率为77.6%,克林霉素、白霉素、环丙沙星的耐药率分别为66.7%、65.6%、57.3%,新喹诺酮类抗菌药物对之有较好的抗菌活性,敏感率皆大于90%,与是否对青霉素、红霉素耐药无关.结论在我国,肺炎链球菌对青霉素、红霉素的耐药率较高,新喹诺酮类抗生素有较好的抗菌活性.     

小儿下呼吸道感染肺炎链球菌耐药性分析

目的了解我院住院患儿感染肺炎链球菌的耐药性状况。方法收集儿科2010年1月至2012年1月患儿连续3次痰培养肺炎链球菌进行耐药分析。采用纸片扩散法（K—B法）,药敏试验结果按NCCL200版判断标准,对照质控菌株判断敏感、中介、耐药。结果所有菌株对万古霉素敏感,耐药率为0,左氧氟沙星敏感率率较高,耐药率为3．3％,菌株对红霉素的耐药率最高,其次为克林霉素。红霉素、克林霉素耐药率为90．2％和89．3％,对复方新诺明、青霉素的敏感率有下降趋势。青霉素G耐药率为82．7％,阿莫西林克拉维酸钾、美洛西林舒巴坦的耐药率13．1％和16．4％,头孢呋辛和头孢噻肟的耐药率分别为18．9％和19．7％。结论儿科冬季下呼吸道感染。肺炎链球菌多见,以婴幼儿多见,早期用药效果欠佳,易出现并发症,并发脓胸、肺脓肿、肺炎、心肌炎,甚至并发感染性休克,应动态监测肺炎链球菌的耐药情况。指导临床合理选择抗生素,提高治愈,减少并发症。     

1330株临床分离革兰阳性菌耐药性分析

目的 了解临床分离的革兰阳性菌对不同抗菌药物的耐药情况,为临床医师及时提供抗生素的耐药动向与耐药变迁为临床抗感染治疗提供选药依据.方法 用苯唑西林检测葡萄球菌临床分离株的敏感性,用纸片扩散法检测革兰阳性菌对四环素、红霉素、庆大霉素、氨苄青霉素、环丙沙星、头孢吡肟、复方磺胺甲噁唑、万古霉素、替考拉宁、利福平、克林霉素等抗菌药物的耐药结果.用E-test法检测对苯唑西林耐药的肺炎链球菌青霉素的MIC值.结果 1330株革兰阳性菌中耐甲氧西林的葡萄球菌对抗菌药物的耐药率显著高于对甲氧两林敏感的葡萄球菌.肠球菌属以粪肠球菌和屎肠球菌检出率最高,粪肠球菌对呋喃妥因、氨苄西林耐药率较低,屎肠球菌耐药性较强,仅对氯霉素、四环素耐药率较低.肺炎链球菌对四环素、克林霉素、红霉素有较高的耐药率,青霉素不敏感肺炎链球菌(PNSSP)的E-test检测结果以中介菌株为主,PNSSP的MIC值最高达到6μg/mL.结论 葡萄球菌、肺炎链球菌对万古霉素全部敏感,有仅发现1株耐万古霉素的屎肠球菌,万古霉素是临床治疗重症革兰阳性菌感染的首选药物.加强耐药性监测对指导临床合理使用抗菌药物具有重要意义.     

223株肺炎链球菌耐药性检测与分析

目的了解本地区肺炎链球菌对临床常用抗菌药物的耐药性。方法对分离培养的肺炎链球菌223株进行药敏试验,分析其对常见抗菌药物的耐药性。结果 223株肺炎链球菌对万古霉素全部敏感,无耐药菌株;而对其他常见抗菌药物均有不同的耐药率。223株肺炎链球菌对抗菌药物的耐药率由大到小排列依次为:红霉素、四环素、克林霉素、苯唑西林、氯霉素、左氧氟沙星。结论可将喹诺酮类抗菌药物作为肺炎链球菌感染的临床经验治疗首选药物。应做好肺炎链球菌的培养与药敏试验,并根据药敏试验结果合理选择抗菌药物。     

南昌地区肺炎链球菌耐药性分析

目的了解南昌地区肺炎链球菌耐药情况,指导临床合理使用抗生素。方法用琼脂稀释法对临床分离的100株肺炎链球菌进行青霉素等12种抗菌药物最低抑菌浓度（M IC）的测定。结果肺炎链球菌对青霉素的不敏感率为57.0%、,其中高度耐药率25.0%,中度耐药率32.0%;头孢呋辛耐药率为38.0%,头孢噻肟、头孢曲松、氯霉素、左氧氟沙星的耐药率分别为12.0%、17.0%、20.0%和7.0%。对红霉素、阿奇霉素、四环素、复方新诺明、克林霉素有较高耐药率,分别为86.0%、90.0%、89.0%、86.0%和90.0%,未检出对万古霉素耐药的菌珠。结论南昌地区肺炎链球菌耐药严重,且多为多重耐药株,临床应合理选择用药。     

重庆地区临床分离肺炎链球菌血清型及耐药分析基因多态性

目的 了解重庆地区的临床分离肺炎链球菌的常见血清型分布及其耐药情况,并对常见血清型菌株和其它血清型菌株的耐药情况进行比较.方法 应用荚膜肿胀实验检测2006年1月～2008年8月临床分离的143株肺炎链球菌的血清型,并采用琼脂稀释法检测常用抗菌药物的最低抑菌浓度(MIC).结果 总的常见血清型为型/群为19群、6群、5型、10群、15群,但从成人分离的菌株常见血清型为19群、10群、5型、33群,儿童则以19群、6群、15群和23群血清型为主.143株菌对阿奇霉素、克林霉素、左氧氟沙星、头孢唑林、青霉素的耐药率(耐药+中介)分别是97.9%、95.8%、4.2%、0.7%、58.1%,对于青霉素的敏感率是42%.常见血清型肺炎链球菌对5种抗菌素的耐药率(耐药+中介)分别是:97.7%、97.7%、1.1%、3.4%、72.4%;其它血清型菌的耐药率分别是:98.2%、92.9%、5.4%、0、35.7%.;仅青霉素耐药率有统计学意义差别.结论 重庆地区临床分离的肺炎链球菌的常见血清型与其它地区报道有一定差别.对左氧氟沙星、头孢唑林耐药率低,对青霉素的耐药率与国内报道接近,但对于阿奇霉素及克林霉素的耐药率高.常见血清型肺炎链球菌对青霉素的耐药率明显高于其它血清型.     

Penicillin resistant Streptococcus pneumoniae isolates in Harare, Zimbabwe

OBJECTIVE: To determine the susceptibility of Streptococcus pneumoniae isolates to penicillin and other antimicrobial drugs. DESIGN: This was a laboratory based study. SETTING: Department of Medical Laboratory Sciences, University of Zimbabwe and the Bacteriology Unit, Public Health Laboratories, Harare. SUBJECTS: 71 S. pneumoniae isolates from Parirenyatwa and Harare hospitals. MAIN OUTCOME MEASURES: Penicillin resistance, MIC of penicillin to S. pneumoniae, multi-drug resistance. RESULTS: 71 S. pneumoniae isolates were tested for their susceptibilities to penicillin G, erythromycin, tetracycline, ampicillin, ciprofloxacin and clindamycin. Five (7%) of the isolates were resistant to penicillin G and were also all resistant to erythromycin. Isolates resistant to other antibiotics were; tetracycline (4), ampicillin (3) and ciprofloxacin (2). The five isolates that were resistant to penicillin G showed resistance to two or more antibiotics. Four S. pneumoniae isolates were designated highly resistant to penicillin (MIC > or = 2 micrograms/ml) and one isolate was designated intermediate in resistance to penicillin (MIC between 0.1 and 1.0 microgram/ml). CONCLUSIONS: A low percentage of S. pneumoniae isolates were resistant to penicillin and were also resistant to erythromycin. The penicillin resistant strains showed multi-drug resistance.     

204株肺炎链球菌的分离鉴定与耐药性分析

目的了解自贡市第四人民医院肺炎链球菌分布和耐药情况。方法对自贡市第四人民医院2006年7月至2009年6月从临床分离的204株肺炎链球菌采用K-B纸片扩散法检测其对青霉素等8种抗生素的敏感度,用E-test法检测对苯唑西林耐药的肺炎链球菌青霉素的MIC值。结果青霉素的耐药呈上升趋势,尤其是2008年7月至2009年6月。肺炎链球菌对四环素、红霉素、克林霉素有较高的耐药率,分别为83.3%、89.2%、90.2%;对青霉素的耐药率为52.5%,对头孢噻肟的耐药率为15.7%;对氯霉素、氧氟沙星的耐药率较低,分别为23.5%、5.4%,未检出对万古霉素耐药的菌株。青霉素不敏感肺炎链球菌(PNSSP)的E-test检测结果以中介菌株为主,PNSSP的MIC值最高达到6μg/mL。结论自贡市第四人民医院分离的肺炎链球菌耐药较为严重,耐青霉素的肺炎链球菌不断上升,有必要对其进行耐药性监测,指导临床合理选择抗菌药物。     

泸州16 418例住院儿童下呼吸道感染细菌病原分布及耐药性分析

目的:了解泸州地区儿童下呼吸道感染细菌病原的分布及耐药情况。方法:采用回顾性研究方法,收集2013 年7 月至 2018 年6 月因下呼吸道感染入住西南医科大学附属医院儿科的患儿痰液细菌培养及药敏试验结果16 418 份,分析常见细菌的 耐药情况。结果:16 418 份痰标本中,5 298 份(32. 3%) 检出细菌或真菌( 真菌相对较少,暂不重点讨论)。其中,革兰阳性菌 2 076 株(39. 2%),主要为金黄色葡萄球菌1 148 株、肺炎链球菌848 株等;革兰阴性菌2 766 株(52. 2%),主要为大肠埃希菌 858 株、肺炎克雷伯菌857 株等。金黄色葡萄球菌对头孢西丁、氨苄西林、青霉素、克林霉素、红霉素的耐药率较高( >60%),对 苯唑西林、头孢曲松敏感率较高(>74%)。肺炎链球菌对克林霉素、红霉素的耐药率高( >80%),对碳青霉烯类抗菌药物、青霉 素、头孢呋辛、头孢曲松高度敏感(>98%)。暂未发现对利奈唑胺及万古霉素耐药的金黄色葡萄球菌或肺炎链球菌。大肠埃希 菌、肺炎克雷伯菌、铜绿假单胞菌对第三代、第四代头孢菌素的敏感率均<67%。铜绿假单胞菌对碳青霉烯类抗菌药物的耐药率 较高(16. 9%~34. 6%)。结论:泸州地区儿童下呼吸道感染细菌病原以革兰阴性菌为主,临床应同时监测细菌对常用抗菌药物 的耐药性和敏感性,促进抗菌药物合理应用,及时控制细菌病原的传播。     

In vitro activities of the oxazolidinone compounds linezolid (PNU-100766) and eperzolid (PNU-100592) against middle ear isolates of Streptococcus pneumoniae.

Two hundred and sixteen isolates of Streptococcus pneumoniae recovered between 1994 and 1996 from the middle ears of children with acute otitis media were tested for their susceptibility to penicillin, erythromycin, clindamycin and the oxazolidinones, linezolid (PNU-100766) and eperezolid (PNU-100592). There were 116 isolates from the Children's Hospital of Pittsburgh and 100 isolates from a national collection. Eighty percent of the local strains were susceptible to penicillin (MIC < 0.1 mg/l); 20% of the local strains and all of the national strains had reduced susceptibility to penicillin. All strains of S. pneumoniae tested had an MIC < 2.0 mg/l for both oxazolidinones. A regional difference was noted in the frequency of resistance to erythromycin with local isolates being more susceptible than isolates from the national collection. This difference was most pronounced among the high-level penicillin-resistant strains of S. pneumoniae.     

Comparative in vitro activity of antiribosomal agents on penicillin-susceptible and -resistant Streptococcus pneumoniae in relation to their resistance genotypes

A collection of 326 strains of Streptococcus pneumoniae isolated from blood, cerebrospinal fluid, bronchoalveolar lavage, transtracheal aspirate or sputum from January 1996-June 2002 were included in this study. The activity of clarithromycin, clindamycin, telithromycin, linezolid and quinupristin/dalfopristin against penicillin G and erythromycin A susceptible and resistant pneumococci were determined; the erythromycin A resistance phenotypes and genotypes were identified and susceptibilities of these agents were assessed according to the resistance genotypes. MICs were determined for all strains of pneumococci using an agar dilution method. MLS(B) resistance phenotypes were determined by the double disk (erythromycin A and clindamycin) diffusion method. Genetic determinants for macrolide resistance were identified by PCR using primers specific for erm(B) and mef(A). Erythromycin A resistance was detected in 13.8% of the strains. MLS(B) resistance phenotype was observed in 82% of these (60% being cMLS(B) and 40% being iMLS(B)), and M type resistance in about 18%. All the MLS(B) phenotype strains except four, revealed the presence of erm(B) gene and all except one M phenotype strains revealed the mef(A) gene. Of the erythromycin A resistant pneumococci about 49% were also resistant to clindamycin. No strains were resistant to telithromycin, quinupristin/dalfopristin and linezolid. Telithromycin had the lowest MIC values for both erythromycin A resistant and susceptible strains of all the antiribosomal agents tested. The most prevalent mechanism of macrolide resistance was mediated by the erm(B) gene leading to the expression of MLS(B) phenotype. Telithromycin was the most active antiribosomal agent, regardless of the macrolide resistance genotype of the pneumococci tested.     

Antimicrobial resistance of Streptococcus pneumoniae and Haemophilus influenzae in Sao Paulo, Brazil from 1996 to 2000

This study was undertaken to assess the in vitro activity of several antimicrobial agents against Brazilian isolates of Streptococcus pneumoniae and Haemophilus influenzae from 1996 to 2000. The antibiotics used were penicillin, amoxicillin/clavulanic acid (A/C), ampicillin, amoxicillin, cefaclor, cefdinir, cefixime, cefprozil, ceftriaxone, cefuroxime, azithromycin, clarithromycin, erythromycin, ciprofloxacin, levofloxacin, ofloxacin, chloramphenicol, clindamycin, doxycycline and trimethoprim/sulphamethoxazole (T/S). MICs were determined by the National Committee for Clinical Laboratory Standards (NCCLS) method and interpreted using NCCLS and PK/PD breakpoints. For S. pneumoniae 80.0% were penicillin susceptible, 18.3% intermediate, 1.7% resistant; most active agents were amoxicillin, A/C, ceftriaxone and levofloxacin; T/S was the least active agent. Beta-lactamase was produced by 13.7% of H. influenzae. All were susceptible to A/C, cefdinir, cefixime, ceftriaxone and quinolones. The least active agents were T/S and macrolides.     

High prevalence of carriage of antibiotic-resistant Streptococcus pneumoniae in children in Kampala Uganda

There are few data on antibiotic-resistant Streptococcus pneumoniae in Uganda. A total of 191 healthy children in Kampala, Uganda were screened for nasopharyngeal carriage of S. pneumoniae; 118 (62%) of the children were carriers. Antimicrobial susceptibility and serotype of 115 strains was determined. Ninety-six (83.5%) of the isolates were of intermediate resistance to penicillin and 19 (16.5%) were susceptible. All strains were susceptible to cefotaxime. The rates of resistance to other drugs were trimethoprim-sulphamethoxazole (83.5%), tetracycline (28.7%) and chloramphenicol (10.4%). All strains were susceptible to rifampicin, erythromycin and clindamycin. Serogroups 6, 9, 14, 19 and 23 accounted for 80% of the isolates. These data show that the rate of carriage of antibiotic-resistant pneumococci by children is high in Kampala, Uganda.     

应用CLSI新的折点值标准判读儿童分离的肺炎链球菌非脑膜炎株的耐药性

目的应用美国临床和实验室标准化研究所(Clinical and Laboratory Standards Institute,CLSI)新的折点值标准,比较2001—2002年和2008年儿童分离的肺炎链球菌非脑膜炎株对青霉素及其它抗生素的耐药情况。方法肺炎链球菌的药物敏感试验采用Kirby-Bauer法,青霉素最低抑菌浓度检测采用E-test法,药敏结果参照2010年CLSI M100-S20版指南判读;组间率的比较采用χ2检验。结果 2008年度83.7%的菌株对青霉素敏感,15.1%中介,1.2%耐药,青霉素MIC50和MIC90分别为1.0μg/mL和3.0μg/mL;2001～2002年97.5%的菌株对青霉素敏感,2.5%中介,无耐药株,青霉素MIC50为0.064μg/mL,MIC90为1.5μg/mL,两者耐药率有显著性差异(χ2=23.48,P<0.05)。所有菌株对万古霉素敏感。菌株对红霉素的耐药率最高,在两个时期分别达92.2%和91.4%。结论本地区2008年度分离的肺炎链球菌对青霉素的敏感率较2001～2002年明显下降,但总体敏感率仍维持在较高水平,青霉素仍可作为治疗该菌颅外感染的一线有效药物。     

Viridans group streptococci in blood culture isolates in a Swedish university hospital: antibiotic susceptibility and identification of erythromycin resistance genes

One hundred and twenty-nine isolates of viridans group streptococci in blood cultures from patients with septicaemia or endocarditis isolated between 1998 and 2003 were tested for antibiotic susceptibility to penicillin, ciprofloxacin, clindamycin, dalbavancin, daptomycin, erythromycin, linezolid, tigecycline, trimethoprim/sulphamethoxazole and vancomycin. Reduced susceptibility to penicillin (minimum inhibitory concentration (MIC) > or =0.25 microg/mL) was found in 18% of the isolates, and 4% of the strains were resistant to penicillin (MIC> or =4.0 microg/mL). Nineteen percent of the isolates had reduced susceptibility to erythromycin (MIC> or =0.5 microg/mL), among which ermB and mefA were found in 40% and 80%, respectively. Strains sequenced as Streptococcus mitis by rnpB had a high degree of non-susceptibility to erythromycin (32%) and penicillin (21%). The level of penicillin resistance in this Swedish study was lower compared with studies from other countries where the antibiotic pressure might be higher than in Sweden. Susceptibility to newer antibiotics was high; all strains were susceptible to dalbavancin, daptomycin, linezolid and vancomycin.