CAJ | 학술논문

目的：了解流感嗜血杆菌的临床分布，分析其耐药性，为临床合理选用抗菌药物提供依据。方法对2010年1月-2012年12月本院临床标本中分离的流感嗜血杆菌，采用VITEK2-compact全自动细菌分析仪进行鉴定，法国生物梅里埃公司ATB HAEMO 5药敏条进行药敏试验，按CLSI 2012年版标准判断结果，头孢硝噻吩纸片法进行β-内酰胺酶检测，应用WHONET 5．6软件进行统计和分析。结果3年间我院共分离出流感嗜血杆菌201株，其中来自痰液标本193株，占96．0％，支气管灌洗液6株，占2．9％，血液2株，占1．1％；科室分布以呼吸科（104株，占51.7％）、外科（31株，占15．4％）、ICU（27株，占13．4％）为主；流感嗜血杆菌对利福平敏感率最低，仅45．5％，其次为氨苄西林73．4％，对氯霉素、复方新诺明敏感率分别为87．5％、87．1％，而对阿莫西林/克拉维酸、头孢噻肟、头孢克洛、四环素、头孢呋辛、氧氟沙星敏感率较高，均在90％以上。成人分离株对氨苄西林及利福平敏感性明显高于儿童分离株，但对四环素，儿童分离株的敏感性高于成人分离株；β-内酰胺酶阳性菌株52株，产酶率为25．9％；其中儿童分离株产酶检出率（31．8％）明显高于成人分离株（22．3％）。结论流感嗜血杆菌对利福平有较高的耐药率，而阿莫西林/克拉维酸、头孢噻肟、头孢克洛、头孢呋辛、氧氟沙星仍是目前治疗流感嗜血杆菌感染的有效抗生素。合理、慎用抗生素对提高呼吸道感染的治愈率、缩短病程，减慢耐药菌株的快速增长有重要意义。
목적：료해류감기혈간균적림상분포，분석기내약성，위림상합리선용항균약물제공의거。방법대2010년1월-2012년12월본원림상표본중분리적류감기혈간균，채용VITEK2-compact전자동세균분석의진행감정，법국생물매리애공사ATB HAEMO 5약민조진행약민시험，안CLSI 2012년판표준판단결과，두포초새분지편법진행β-내선알매검측，응용WHONET 5．6연건진행통계화분석。결과3년간아원공분리출류감기혈간균201주，기중래자담액표본193주，점96．0％，지기관관세액6주，점2．9％，혈액2주，점1．1％；과실분포이호흡과（104주，점51.7％）、외과（31주，점15．4％）、ICU（27주，점13．4％）위주；류감기혈간균대리복평민감솔최저，부45．5％，기차위안변서림73．4％，대록매소、복방신낙명민감솔분별위87．5％、87．1％，이대아막서림/극랍유산、두포새우、두포극락、사배소、두포부신、양불사성민감솔교고，균재90％이상。성인분리주대안변서림급리복평민감성명현고우인동분리주，단대사배소，인동분리주적민감성고우성인분리주；β-내선알매양성균주52주，산매솔위25．9％；기중인동분리주산매검출솔（31．8％）명현고우성인분리주（22．3％）。결론류감기혈간균대리복평유교고적내약솔，이아막서림/극랍유산、두포새우、두포극락、두포부신、양불사성잉시목전치료류감기혈간균감염적유효항생소。합리、신용항생소대제고호흡도감염적치유솔、축단병정，감만내약균주적쾌속증장유중요의의。
Objective To investigate the distribution and antimicrobial resistance of haemophilus influenzae ,and to pro-vide reference for reasonable use of antibiotics .Methods Clinical isolates from patients in our hospital from January 2010 to December 2012 were identified by VITEK2-compact automatic identification system , bacterial susceptibility tests were per-formed on strains by ATB system , the results were determined according to the guidelines of CLSI in 2012,and β-lactamase was detected by nitrocefin disk diffusion method .WHONET5.6 software was applied for data analysis .Results A total of 201 strains of haemophilus influenzae were obtained from our hospital in recent three years .Among them,193 strains were from sputum specimen (96.0%),6 from bronchoalveolar lavage fluid specimen (2.9%),2 from blood specimen (1.1%).As for the distribution of haemophilus influenzae in clinical departments ,the top three were respiratory department (104 strains, 51. 7%),surgical department (31 strains,15.4%) and ICU (27 strains,13.4%).The results of bacterial susceptibility tests showed that haemophilus influenzae was sensitive to rifampicin , ampicillin,chloramphenicol and cotrimoxazole with a rate of 45.5%,73.4%,87.5%and 87.1%respectively,and that the sensitive rate of haemophilus influenzae to amoxicillin /clavu-lanic acid,cefotaxime,cefaclor,tetracycline, cefuroxime and ofloxacin was higher than 90%.Isolates from adults were more sensitive to ampicillin and rifampicin than those from children ,but for tetracycline , isolates from children were more sensitive than those from adults .52 strains were positive to β-lactamase with a rate of 25.9%, and the rate of β-lactamase positive strains from children was significantly higher than that from adults .Conclusion Haemophilus influenzae has a higher resistant rate to rifampicin.Amoxicillin /clavulanate,cefotaxime,cefaclor,cefuroxime and ofloxacin are still the effective antibiotics for the control of haemophilus influenzae infections .Reasonable and cautious use of antibiotics is important for improving the cure rate of respiratory infections ,shortening the course and slowing down the rapid growth of resistant strains .