Objective To investigate the antimicrobial resistance and clinical distribution of the isolates of Heamophilus influenzae in Zhongshan, and to provide the basis for clinical experience.
Methods Totally 406 strains of Haemophilus influenzae isolated from clinical specimens from Zhongshan Hospital affiliated to Sun Yat–sen University were selected from 2014 to 2017. The drug sensitivity test was performed by K–B method, and the cephalosporin paper method was used for β–lactamase detection. PCR technique was employed for ftsI genotyping.
Results Of the 406 strains of Haemophilus influenzae, 363 strains were sputum specimens, accounting for 89.4%, and 31 throat secretions, accounting for 7.6%. Among the departments, the proportion of respiratory medicine and general pediatrics was the highest, respiratory medicine accounted for 16.3%, and general pediatrics accounted for 17.2%. The age was below 10 years old, accounting for 22.4%, and over 51 years old, accounting for 57.9%. More men accounted for 68.9% of the gender distribution. The resistance rate of ampicillin increased year by year, and the resistance rate of ampicillin/sulbactam was much lower than that of ampicillin. No drug–resistant strains were found in ciprofloxacin, azithromycin, cefpodoxime, ceftriaxone, levofloxacin, and meropenem. There was a significant regional difference in the resistance rate of ampicillin in the geographical distribution. The detection rate of β–lactamase nonproducing–ampicillin–resistant (BLNAR) in the four years was the highest in 2015, reaching 21.3%, and it was 14.4% in 2017. β–lactamase–negative ampicillin–resistant Haemophilus influenzae detected ftsI gene mutation mainly in type III.
Conclusion The resistance rate of Haemophilus influenzae to ampicillin increased year by year. No drug–resistant strains were found in ciprofloxacin, chloramphenicol cefpodoxime, ceftriaxone, levofloxacin and meropenem. The rational use of antibiotics should be based on the result of antibiotics sensitivity.
摘要： 目的 了解中山市流感嗜血杆菌的临床分布并对其耐药性进行分析, 为更好地指导临床用药提供依据。 方法 选取中山大学附属中山医院2014—2017年从临床标本中分离的406株流感嗜血杆菌, 用K-B法进行药敏试验, 头孢硝噻吩纸片法进行β-内酰胺酶检测, 用PCR 方法对分离菌株进行 ftsI 基因检测。 结果 在406株流感嗜血杆菌中, 来源痰液标本363株, 占89.4%, 咽喉分泌物31株, 占7.6%。科室分布中, 以呼吸内科和普通儿科比例最高, 呼吸内科占16.3%, 普通儿科占17.2%。年龄10岁以下占22.4%, 51岁以上占57.9%。性别分布上男性多于女性占68.9%。氨苄西林的耐药率逐年增高, 氨苄西林/舒巴坦的耐药率远低于氨苄西林, 环丙沙星、阿奇霉素、头孢泊肟、头孢曲松、左旋氧氟沙星、美洛培南未发现耐药株。在地域分布上氨苄西林的耐药率有着明显的地域差异。β-内酰胺酶阴性氨苄西林耐药的菌株 (β-lactamase nonproducing-ampicillin-resistant, BLNAR) 在这四年间检出率2015年最高, 达21.3%, 2017 年降为14.4%。β-内酰胺酶阴性氨苄西林耐药的流感嗜血杆菌均检出ftsI 基因突变以Ⅲ型为主。 结论 流感嗜血杆菌对氨苄西林的耐药率逐年上升, 环丙沙星、阿奇霉素、头孢泊肟、头孢曲松、左旋氧氟沙星、美洛培南未发现耐药株, 临床应该根据药敏结果合理使用抗生素。