| 摘要: |
| 目的：探讨呼吸道感染患儿不可分型流感嗜血杆菌（NTHi）的分离率和耐药性。方法：收集2016年1月至2018年12月我院儿科门诊和住院部收治的7 843例呼吸道感染患儿的痰液标本，分别进行细菌分离和鉴定、血清学分型、药敏试验及β-内酰胺酶表型检测，统计NTHi的分离率、β-内酰胺酶表型、耐药率和3年变迁情况。结果：共分离出927株流感嗜血杆菌（Hi），总分离率11.82%，其中NTHi为280株，占Hi株数的30.20%，占总标本数的3.57%。NTHi在Hi中和总体标本中的分离率呈逐年上升趋势（P<0.01），NTHi在Hi和总体标本中的分离率随年龄增加呈下降趋势（P<0.01）。NTHi对氨苄西林和复方磺胺甲噁唑耐药率较高，分别为29.64%和43.57%，对阿奇霉素和亚胺培南的耐药率较低，分别为0.36%和0.71%。NTHi对氨苄西林和复方磺胺甲噁唑的耐药率均呈逐年上升趋势（P<0.05），对其余抗菌药物耐药率随时间变化有所上升，但未呈逐年上升趋势（P>0.05）。280株NTHi中β-内酰胺酶阳性菌株检出率为30.71%，呈逐年上升趋势（P<0.05），NTHi中β-内酰胺酶阳性菌株对氨苄西林、头孢呋辛、亚胺培南和复方磺胺甲噁唑的耐药率显著高于β-内酰胺酶阴性菌株（P均<0.05）。结论：NTHi的分离率和β-内酰胺酶阳性菌株检出率均呈逐年上升趋势。大环内酯类药物阿奇霉素、第二代和第三代头孢菌素则具有相对较低的耐药率，不良反应在可接受范围内，可作为NTHi感染的首选用药。 |
| 关键词: 呼吸道感染 不可分型 流感嗜血杆菌 β-内酰胺酶 耐药性 |
| DOI： |
|
| 基金项目:浙江省科技计划项目,编号2015C33265 |
|
| Analysis of Isolation Rate and Drug Resistance of Nontypeable Haemophilus Influenzae in Children with Respiratory Tract Infection |
| Yang Yaofeng, Xu Lanfei, Jin Hongxing, Wang Rongshan |
| ((Yiwu Maternal and Child Health Care Hospital, Zhejiang Yiwu 322000, China)) |
| Abstract: |
| Objective: To investigate the isolation rate and drug resistance of nontypeable Haemophilus influenzae (NTHi) in children with respiratory tract infection. Methods: A total of 7,843 qualified sputum specimens from children with respiratory tract infection admitted into our hospital from Jan. 2016 to Dec. 2018 were extracted for bacterial isolation and identification, serological typing, drug susceptibility test and β-lactamase phenotype detection. The isolation rate of NTHi, β-lactamase phenotype, drug resistance rate and three-year change were counted. Results: A total of 927 strains of Haemophilus influenzae (Hi) were isolated, the total isolation rate was 11.82%. And 280 strains were NTHi, accounting for 30.20% of the Hi strains and 3.57% of the general specimen. The isolation rate of NTHi in Hi strains and general specimens increased year by year (P<0.01). The isolation rate of NTHi in Hi strains and general specimens showed the downward trend with increase of age (P<0.01). NTHi had higher drug resistance rate to ampicillin and compound sulfamethoxazole, the drug resistance rate was 29.64% and 43.57% respectively. NTHi had lower drug resistance rate to azithromycin and imipenem, the drug resistance rate was 0.36% and 0.71% respectively. The drug resistance rate of NTHi to ampicillin and compound sulfamethoxazole both showed the upward trend year by year (P<0.05), and the drug resistance rate to other antibiotics increased with time, yet it did not increase year by year (P>0.05). The detection rate of β-lactamase positive NTHi strain in 280 strains was 30.71%, which showed the increasing trend year by year (P<0.05). The drug resistance rate of β-lactamase positive NTHi strains to ampicillin, cefuroxime, imipenem and compound sulfamethoxazole were significantly higher than those of the negative strain of β-lactamase (P<0.05). Conclusion: The isolation rate of NTHi and the detection rate of positive strains of β-lactamase showed the upward trend year by year. Macrolides azithromycin, the second-generation and third-generation cephalosporins had relatively low drug resistance rate and acceptable adverse drug reactions, which can be the first option for NTHi infection. |
| Key words: respiratory tract infection nontypeable, Haemophilus influenzae β-lactamase drug resistance |
