CAJ | 학술논문

目的：了解深圳市宝安区小于5岁儿童肺炎链球菌抗生素耐药性特征，为临床用药提供依据。方法E-test法检测SP对青霉素和头孢曲松的MIC，K-B法检测其他抗生素的敏感性，采用CLSI 2008年标准判断抗生素敏感性，用Whonet软件统计分析2009～2013年深圳市宝安区妇幼保健院临床分离自5岁以下儿童肺炎链球菌（ SP）相关性疾病（ PD）来源的SP抗生素耐药性。结果近五年共分离1605株SP，多重耐药菌比例高达86．8％，最常见的耐药模式为：红霉素＋克林霉素＋复方新诺明，对万古霉素和左氧氟沙星的敏感性分别为100.0％和98．8％；对青霉素和头孢曲松的MIC50/90分别为1/2和0．75/2，连续五年MIC50稳定波动，MIC90略有上升趋势；按非脑膜炎标准未检测出耐青霉素SP（ PRSP），按脑膜炎标准和口服标准对青霉素耐药性显著增加分别为88．6％、39．2％；按脑膜炎标准和非脑膜炎标准，SP对头胞曲松的耐药性分别为25．6％和5．5％。结论深圳市宝安区小于5岁儿童SP多重耐药比例高，应避免使用红霉素、克林霉素和复方新诺明治疗PD，非脑膜炎感染SP应尽量选用青霉素，避免选择压力，保护三代头孢菌素敏感性，脑膜炎感染SP则需参考药敏结果选择敏感抗生素。
목적：료해심수시보안구소우5세인동폐염련구균항생소내약성특정，위림상용약제공의거。방법E-test법검측SP대청매소화두포곡송적MIC，K-B법검측기타항생소적민감성，채용CLSI 2008년표준판단항생소민감성，용Whonet연건통계분석2009～2013년심수시보안구부유보건원림상분리자5세이하인동폐염련구균（ SP）상관성질병（ PD）래원적SP항생소내약성。결과근오년공분리1605주SP，다중내약균비례고체86．8％，최상견적내약모식위：홍매소＋극림매소＋복방신낙명，대만고매소화좌양불사성적민감성분별위100.0％화98．8％；대청매소화두포곡송적MIC50/90분별위1/2화0．75/2，련속오년MIC50은정파동，MIC90략유상승추세；안비뇌막염표준미검측출내청매소SP（ PRSP），안뇌막염표준화구복표준대청매소내약성현저증가분별위88．6％、39．2％；안뇌막염표준화비뇌막염표준，SP대두포곡송적내약성분별위25．6％화5．5％。결론심수시보안구소우5세인동SP다중내약비례고，응피면사용홍매소、극림매소화복방신낙명치료PD，비뇌막염감염SP응진량선용청매소，피면선택압력，보호삼대두포균소민감성，뇌막염감염SP칙수삼고약민결과선택민감항생소。
Objective To analyze streptococcus pneumoniae ( SP ) antimicrobial resistance in children less than 5 years old in Shenzhen Bao'an district .Methods E-test method was used for antimicrobial resistance of penicillin and ceftriaxone .K-B method was used for other antimicrobial sensitivity .Breakpoints were based on the 2008 criteria of the Clinical and Laboratory Standards Institute ( CLSI ) .Whonet software analysis was used to analyzed the antimicrobial resistance of SP in children less than 5 years old from 2009 to 2013 in Bao'an Maternity and Child Health Hospital .Results E-test method was used for antimicrobial resistance of penicillin and ceftriaxone .K-B method was used for other antimicrobial sensitivity .Breakpoints were based on the 2008 criteria of the Clinical and Laboratory Standards Institute ( CLSI ) .Whonet software analysis was used to ana-lyzed the antimicrobial resistance of SP in children less than 5 years old from 2009 to 2013 in Bao'an Maternity and Child Health Hospital .Conclusion MDRSP ratio is high in children less than 5 years old in local place . Something should be done to avoid the use of erythromycin , clindamycin and trimethoprim-sulphamethoxazole in treating PD.Penicillin is good choice for nonmeningitis SP infection .For meningitis infection SP , antimicrobial susceptibility results is more reliable .