CAJ | 학술논문

目的：为了解广州地区抗菌药物管理初期近10年下呼吸道住院病人分离的肺炎链球菌及流感嗜血杆菌耐药性的变迁。方法将3个不同时期[2003年6月—2004年12月(第1期)、2006年2月—2007年2月(第2期)、2011年1月—2012年6月(第3期)]，下呼吸道感染病人痰标本进行细菌培养，用Etest检测及K-B法纸片对其中分离出的肺炎链球菌和流感嗜血杆菌进行常用抗菌药物的耐药性情况检测，分析比较3个时期的检测结果。结果3个时期肺炎链球菌培养结果分别为第1期172株，第2期79株，第3期391株；耐药性变化趋势中，青霉素、头孢呋辛、红霉素、克林霉素耐药性呈现上升趋势，且3个时期耐药性差异有统计学意义(均为P<0.001)。3个时期流感嗜血杆菌培养结果分别为第1期484株，第2期140株，第3期524株；耐药性变化趋势中，氨苄西林、阿莫西林/克拉维酸、头孢克洛、头孢呋辛、阿奇霉素耐药性呈现上升趋势，且3个时期耐药差异有统计学意义(均为P<0.001)；四环素、头孢曲松耐药性呈现下降趋势，且3个时期耐药差异有统计学意义(均为P<0.001)。结论近10年中，肺炎链球菌对儿科常用抗菌药物包括青霉素、头孢呋辛、红霉素、克林霉素的耐药情况仍在上升趋势中。流感嗜血杆菌对氨苄西林、阿莫西林/克拉维酸、头孢克洛、头孢呋辛、阿奇霉素的耐药情况也是逐年加重；对头孢曲松的耐药性呈下降趋势。
목적：위료해엄주지구항균약물관리초기근10년하호흡도주원병인분리적폐염련구균급류감기혈간균내약성적변천。방법장3개불동시기[2003년6월—2004년12월(제1기)、2006년2월—2007년2월(제2기)、2011년1월—2012년6월(제3기)]，하호흡도감염병인담표본진행세균배양，용Etest검측급K-B법지편대기중분리출적폐염련구균화류감기혈간균진행상용항균약물적내약성정황검측，분석비교3개시기적검측결과。결과3개시기폐염련구균배양결과분별위제1기172주，제2기79주，제3기391주；내약성변화추세중，청매소、두포부신、홍매소、극림매소내약성정현상승추세，차3개시기내약성차이유통계학의의(균위P<0.001)。3개시기류감기혈간균배양결과분별위제1기484주，제2기140주，제3기524주；내약성변화추세중，안변서림、아막서림/극랍유산、두포극락、두포부신、아기매소내약성정현상승추세，차3개시기내약차이유통계학의의(균위P<0.001)；사배소、두포곡송내약성정현하강추세，차3개시기내약차이유통계학의의(균위P<0.001)。결론근10년중，폐염련구균대인과상용항균약물포괄청매소、두포부신、홍매소、극림매소적내약정황잉재상승추세중。류감기혈간균대안변서림、아막서림/극랍유산、두포극락、두포부신、아기매소적내약정황야시축년가중；대두포곡송적내약성정하강추세。
Objective To investigate the change of antibiotic resistance of Streptococcus pneumoniae ( Sp) and Haemophilus influenzae ( Hi ) isolated from in-patient children with low-respiratory tract infection during early phase interventions promoting antibiotic use in Guangzhou. Methods Sputum specimens from in-patient children with low-respiratory tract infection were collected and cultured,and then Sp and Hi strains were isolated and identified in three different periods including from June 2003 to December 2004, from February 2006 to February 2007 and from January 2011 to June 2012. K-B disc diffusion and E-test for antibiotic susceptibility were performed for these clinical isolates. Results 172,79 and 391 Sp strains were isolated in three different periods,respectively. Antibiotic resistance to penicillin,cefuroxime,erythromycin and clindamycin was increased yearly. 484,140 and 524 Hi strains were isolated in three different periods, respectively. Antibiotic resistance to ampicillin, amoxicillin/clavulanic acid, cefaclor, cefuroxime and azithromycin was increased yearly, but drug resistance to tetracycline and ceftriaxone was decreased. Conclusion The resistance of Sp strains to penicillin, cefuroxime, erythromycin and clindamycin is increased in recent 10 years. Meantime,the resistance of Hi strains to antibiotics commonly used in children like ampicillin,amoxicillin/clavulanic acid,cefaclor,cefuroxime and azithromycin is still increasing,but not to ceftriaxone.