【摘要】 目的调查2005—2006年中国社区呼吸道常见病原菌的耐药性。方法收集2005年1月—2006年9月全国9家医院社区呼吸道感染患者中分离的417株肺炎链球菌、208株流感嗜血杆菌、76株卡它莫拉菌和66株 A 群 B 溶血链球菌。琼脂稀释法测定莫西沙星等10种抗菌药物的最低抑菌浓度(MICs)。结果全国9家医院,青霉素中介的肺炎链球菌(PISP)为23.0%,青霉素耐药的(PRSP)为24.5%。来自儿童的肺炎链球菌对青霉素的敏感性明显低于成人组(30.6%vs.64.5%,P<0.001)。成人组中,上海瑞金医院 PISP 和 PRSP 明显高于其他8家医院(PISP 46.7%vs.15.3%,40.O%vs.17.3%,P=0.002)。青霉素对417株肺炎链球菌的 MIC 范围为0.008～4μg/ml。PRSP对头孢克洛、头孢丙烯、阿莫西林/克拉维酸和头孢曲松的敏感性分别为2.9%、2.9%、53.9%、58.8%,未发现对莫西沙星和左氧氟沙星不敏感的 PRSP。19.2%的流感嗜血杆菌和92.1%的卡它莫拉菌产生β内酰胺酶。流感嗜血杆菌对头孢克洛、头孢丙烯的敏感性(88.9%、92.3%)低于其对阿莫西林/克拉维酸、头孢曲松、阿奇霉素、左氧氟沙星、莫西沙星的敏感性(99.5%～100%)。卡它莫拉菌对上述药物的敏感性为92.1%～100%。9家医院流感嗜血杆菌β内酰胺酶的发生率最高的是杭州(41.9%)、广州(37.5%),其次是上海(26.3%～29.6%)、武汉(13.0%),最低的是北京和沈阳(≤3.3%);成人组流感嗜血杆菌的产酶率高于儿童组(22.1%vs.11.1%,P<0.05)。未发现对青霉素耐药的 A 群β溶血链球菌。肺炎链球菌、A 群β溶血链球菌对阿奇霉素耐药率高于75%。莫西沙星对肺炎链球菌、A 群β溶血链球菌的 MICs 比左氧氟沙星低4～8倍。结论不同年龄组、不同地区肺炎链球菌和流感嗜血杆菌的耐药性均有差异。革兰阳性球菌对大环内酯类的高耐药性值得关注,莫西沙星对呼吸道病原菌有优秀的抗菌活性。更多还原

【Abstract】 Objective To investigate antimicrobial agents resistance of common community respiratory pathogens isolated in China,2005-2006.Methods 417 isolates of Streptococcus pneumoniae, 208 Haemophilus influenzae,76 Moraxella catarrhalis,and 66 Group A β-haemolytic Streptococci were collected from patients with community-acquired respiratory tract infections at 9 big teaching hospitals in China from January 2005 to September 2006.Agar dilution method was used to determine the minimal inhibitory concentration(MICs)of moxifloxacin and other 9 antibiotics against these isolates.Results Penicillin- intermediate S.pneumoniae(PISP)was 23.0% and penicillin-resistant S.pneumoniae(PRSP)was 24.5% at 9 hospitals in China.Susceptibility to penicillin in S.pneumoniae differed significantly between children and adults(30.6% vs.64.5%,P<0.001).Among the adults group,the prevalence of PISP and PRSP were higher than those of other 8 hospitals(PISP 46.7% vs.15.3%,40.0% vs.17.3%, P = 0.002).Penicillin MICs ranged from 0.008 to 4 μg/ml.Susceptibility rates of PRSP to cefaclor, cefprozil,amoxicillin/clavulanate and ceftriaxone were 2.9%,2.9%,53.9% and 58.8%,respectively. No PRSP was found to be resistant to levofloxacin and moxifloxaein.19.2% of H.influenzae and 92.1% of M.catarrhalis produced β-lactamases.The susceptibility of cefaclor and eefprozil in H.influenzae was lower than those of amoxicillin/clavulanate,ceftriaxone,azithromycin,levofloxaein and moxifloxaein(88.9%- 92.3% vs.99.5% to 100%).The susceptibility of the above antimicrobials in M.eatarrhalis ranged form 92.1% to 100%.The prevalence of β-lactamases in H.influenzae was highest in Hongzhou(41.9%)and Guangzhou(37.5%),followed by Shanghai(26.3%-29.6%),Wuhan(13.0%),Beijing and Shenyang (<3.3%).The prevalence of β-lactamases in H.influenzae was significantly higher in adults than in children(22.1% vs.11.1%,P<0.05).No Group A β-haemolytic Streptococci isolates were resistant to penicillin.The resistance rate of S.pneumoniae and Group A β-haemolytic Streptococci to azithromycin was higher than 75%.Moxifloxacin MICs against S.pneumoniae,Group A β-haemolytic Streptococci were 4-8 fold lower than levofloxacin.Conclusions Antimicrobial resistance in S.pneumoniae and H.influenzae differs in different age groups and different areas.It brings concerns that high macrolides resistance was found in gram-positive cocci.Moxifloxacin has an excellent activity against respiratory pathogens.更多还原