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目的:了解小儿下呼吸道感染肺炎链球菌的耐药性,以指导临床合理用药。方法:对2011年1月~2013年12月间,年龄38天~6岁的下呼吸道感染的1862名住院患儿进行痰培养,采用链球菌细菌鉴定板鉴定,并行药敏试验。结果:经痰培养确诊232例肺炎链球菌感染,检出率为12.72%。分离出的肺炎链球菌对常用抗生素耐药率分别为:青霉素28.9%,阿莫西林31.9%,红霉素89.7%,头孢噻肟35.3%,阿奇霉素90.1%,复方新诺明33.6%,万古霉素0%,克林霉素53.4%,左氧氟沙星6.5%,氯霉素6.9%;青霉素不敏感肺炎链球菌(PNSSP)对红霉素,克林霉素,头孢噻肟,头孢曲松,氧氟沙星的耐药率高于青霉素敏感肺炎链球菌(PSSP)。多重耐药率达76.6%,208株耐红霉素肺炎链球菌中,ermB基因介导的占60.6%,由mefE基因介导的占39.4%。结论:下呼吸道感染患儿分离的肺炎链球菌对阿奇霉素,红霉素,克林霉素的耐药率较高,对头孢噻肟,复方新诺明和阿莫西林的耐药率呈逐年递增趋势,临床应依据药敏结果合理选用抗菌药物。
Objective: To understand the drug resistance of children with lower respiratory tract infection of Streptococcus pneumoniae, in order to guide clinical rational use of medicine. Methods: From January 2011 to December 2013, 1862 hospitalized children with lower respiratory tract infection aged 38 days to 6 years were sputum culture, identified by streptococcus bacterial identification kit, and tested in parallel with drug susceptibility. Results: 232 cases of S. pneumoniae infection were confirmed by sputum culture, the detection rate was 12.72%. Streptococcus pneumoniae isolates were resistant to commonly used antibiotics: penicillin 28.9%, amoxicillin 31.9%, erythromycin 89.7%, cefotaxime 35.3%, azithromycin 90.1%, cotrimoxazole 33.6%, Vancomycin (0%), clindamycin (53.4%), levofloxacin (6.5%) and chloramphenicol (6.9%). Penicillin-insensitive Streptococcus pneumoniae (PNSSP) The rate of resistance to the sand star is higher than that of penicillin-susceptible Streptococcus pneumoniae (PSSP). The multidrug resistance rate was 76.6%. Among 208 erythromycin resistant Streptococcus pneumoniae strains, ermB gene mediated 60.6% and mefE gene 39.4%. CONCLUSIONS: Streptococcus pneumoniae isolated from children with lower respiratory tract infection have a higher resistance rate to azithromycin, erythromycin and clindamycin, and the rates of resistance to cefotaxime, cotrimoxazole and amoxicillin increase year by year The clinical should be based on drug susceptibility results reasonable selection of antimicrobial agents.