儿童感染金黄色葡萄球菌耐药性分析

目的了解儿童感染金黄色葡萄球菌（SA）的耐药性及红霉素诱导克林霉素耐药情况。方法收集某院2005年1月-2007年9月分离自皮肤科脓疱疮患儿的2086株及其他病区非脓疱疮患儿的158株SA，采用纸片扩散（K-B）法对上述菌株进行13种抗菌药物的药敏分析，并用D-试验检测红霉素诱导克林霉素的耐药表型。结果2086株脓疱疮感染SA对青霉素、红霉素、克林霉素的耐药率较高，分别为96．2％、83．2％、61．9％，对其他抗菌药物的耐药率均较低（0-6．2％）；其中耐甲氧西林SA（MRSA）27株，占1．29％。非脓疱疮感染的SA对青霉素、红霉素、克林霉素的耐药率分别为97．5％、56．9％、32．9％，对头孢菌素耐药率为14．6％-27．3％，对其他抗菌药物耐药率均〈5％；其中MRSA 28株，占17．72％。红霉素耐药而克林霉素敏感菌株共432株，诱导试验阳性232株，红霉素诱导克林霉素耐药的菌株占53．70％。结论儿童脓疱疮感染的SA中MRSA检出率不高，而非脓疱疮感染的SA中MRSA检出率较高，二者对青霉素、大环内酯类、林可酰胺类抗菌药物耐药较严重，对其他抗菌药物耐药率不高。开展D-试验检测红霉素诱导克林霉素耐药的表型可帮助临床医生正确使用大环内酯类、林可酰胺类、链阳霉素B类抗菌药物。

Analysis on drug-resistance of Staphylococcus aureus causing infection in children

Objective To realize the drug-resistance of Staphylococcus aureus in infected children and clindamycin resistance induced by erythromycin.Methods Staphylococcus aureus were collected from patients who were hospitalized between January 2005 and December 2007,2 086 strains were isolated from children with impetigo herpetiformis in department of dermatology and 158 strains were from children without impetigo herpetiformis in the other departments,analysis was made on antimicrobial susceptibility tests of the above strains against 13 kinds of antimicrobial agents performed with Kirby-Bauer methods,drug-resistant phenotype of clindamycin induced by erythromycin was detected by D-test.Results The drug-resistant rates of 2 086 strains of Staphylococcus aureus causing impetigo herpetiformis to penicillin,erythromycin and clindamycin were high,which were 96.2%,83.2% and 61.9% respectively,but drug-resistant rates to the other antimicrobial agents were low(0~6.2%);27 strains(1.29%)were methicillin-resistant Staphylococcus aureus(MRSA).The drug-resistant rates of Staphylococcus aureus causing non-impetigo herpetiformis infection against penicillin,erythromycin and clindamycin were 97.5%,56.9% and 32.9% respectively,drug-resistant rates to cephalosporins were 14.6%~27.3%,drug-resistant rates against the other antimicrobial agents were all<5%;28 strains(17.72%)were MRSA,432 strains were erythromycin-resistant but clindamycin-sensitive,232 strains were positive in inducible test,53.70% strains were clindamycin-resistant strains induced by erythromycin.Conclusion The detection rate of MRSA was low in children with impetigo herpetiformis but high in non-impetigo herpetiformis infection,both were highly resistant to penicillins,macrolides and lincosamides,but the resistant rates to the other antimicrobial agents were low.The detection of D-test to determine the phenotype of lincomycin induced by erythromycin can help clinicians to use macrolides,lincosamides and streptogramin correctly.