儿童下呼吸道卡他莫拉菌的耐药性研究
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摘要
目的对儿童下呼吸道分离的卡他莫拉菌感染情况及耐药性进行研究,指导临床诊断和用药。方法选取2015年1月-2017年12月广东省中山市博爱医院儿科门诊和住院部下呼吸道感染患儿,对其痰液标本进行卡他莫拉菌的分离培养,并进行鉴定及药敏试验。结果共计25598例下呼吸道感染患儿,分离得卡他莫拉菌3 055株,卡他莫拉菌检出率为11.93%,卡他莫拉菌感染以秋冬季高发,1～6岁多见,混合感染率为44.03%,以肺炎链球菌混合感染最多。卡他莫拉菌对甲氧苄啶-磺胺甲唑、四环素、阿莫西林-克拉维酸的敏感率均高于90%;对红霉素、阿奇霉素、克拉霉素的不敏感率均接近30%。结论 1～6岁儿童是秋冬季感染卡他莫拉菌的高危人群,且混合感染率较高,其感染特点及耐药状况应受临床关注。
Objective To examine the clinical features and antibiotic resistance profile of Moraxella catarrhalis in children with lower respiratory tract infection for rational use of antimicrobial agents. Methods The children with lower respiratory tract infection treated in pediatric department of Zhongshan Boai Hospital from January 2015 to December 2017 were enrolled. The bacterial species were identified and antimicrobial susceptibility determined. Results The prevalence of Moraxella catarrhalis was11.93%(3 055/25 598) in sputum specimens, relatively higher in autumn and winter. Moraxella catarrhalis was mostly isolated from the children of 1-6 years old. Mixed infection was found in 44.03% of the children. Streptococcus pneumoniae was the most common pathogen in the mixed infection of Moraxella catarrhalis. More than 90% of the Moraxella catarrhalis strains were susceptible to trimethoprim-sulfamethoxazole, tetracycline, and amoxicillin-clavulanic acid, but nearly 30% of them were non-susceptible to erythromycin, clarithromycin and azithromycin. Conclusions The children at 1-6 years of age are at high risk of Moraxella catarrhalis infection in autumn and winter. Clinicians should consider the clinical features, mixed infection, and antibiotic resistance profile of Moraxella catarrhalis in clinical diagnosis and treatment.
Objective To examine the clinical features and antibiotic resistance profile of Moraxella catarrhalis in children with lower respiratory tract infection for rational use of antimicrobial agents. Methods The children with lower respiratory tract infection treated in pediatric department of Zhongshan Boai Hospital from January 2015 to December 2017 were enrolled. The bacterial species were identified and antimicrobial susceptibility determined. Results The prevalence of Moraxella catarrhalis was11.93%(3 055/25 598) in sputum specimens, relatively higher in autumn and winter. Moraxella catarrhalis was mostly isolated from the children of 1-6 years old. Mixed infection was found in 44.03% of the children. Streptococcus pneumoniae was the most common pathogen in the mixed infection of Moraxella catarrhalis. More than 90% of the Moraxella catarrhalis strains were susceptible to trimethoprim-sulfamethoxazole, tetracycline, and amoxicillin-clavulanic acid, but nearly 30% of them were non-susceptible to erythromycin, clarithromycin and azithromycin. Conclusions The children at 1-6 years of age are at high risk of Moraxella catarrhalis infection in autumn and winter. Clinicians should consider the clinical features, mixed infection, and antibiotic resistance profile of Moraxella catarrhalis in clinical diagnosis and treatment.
引文
[1]郑红艳，宋文琪，董方，等.儿童患者中分离189株卡他莫拉菌的分布和耐药性分析[J].中国感染与化疗杂志，2016, 16(5):614-617.
[2]孙燕，孔菁，张泓，等. 2005—2014年CHINET流感嗜血杆菌和卡他莫拉菌耐药性监测[J].中国感染与化疗杂志，2016,16(2):153-159.
[3]胡亚美，江载芳.诸福棠实用儿科学[M]. 7版.北京：人民卫生出版社，2002:462.
[4] Clinical and Laboratory Standards Institute. Methods for antimicrobial dilution and disk susceptibility testing of infrequently isolated or fastidious bacteria(M45)[S]. 3rd, 2015.
[5]孙慧明，周卫芳，季伟，等.苏州地区下呼吸道感染住院患儿卡他莫拉菌感染与气候因素相关性研究[J].临床儿科杂志，2014, 32(6):524-527.
[6]袁少伟，李慧.儿童呼吸道卡他莫拉菌感染分布及耐药分析[J].宁夏医学杂志，2014, 36(5):451-453.
[7]李振国，贵琳，黄洋，等.儿童卡他莫拉菌呼吸道感染的耐药性研究[J].中华医院感染学杂志，2016, 26(1):185-187.
[8]杨海娟，陈霞，吴佳辉，等.患儿呼吸道感染91例卡他莫拉菌及耐药性分析[J].陕西医学杂志，2015, 44(5):527-529.
[9]唐萍，史伟，曾海玲，等. 1082例呼吸道感染住院患儿鼻咽部携带卡他莫拉菌状况及其耐药性分析[J].中国当代儿科杂志，2016, 18(8):707-712.
[10] SPANIOL V, TROLLER R, AEBI C. Physiologic cold shock increases adherence of moraxella catarrhalis to and secretion of interleukin 8 in human upper respiratory tract epithelial cells[J]. J Infect Dis, 2009, 200(10):1593-1601.
[11] MORRISSEY I, MAHER K, WILLIAMS L, et al. Nonsusceptibility trends among Haemophilus influenzae and Moraxella catarrhalis from community-acquired respiratory tract infections in the UK and Ireland, 1999-2007[J]. J Antimicrob Chemother, 2008, 62(Suppl 2):ii97-103.
[12]张玲，程方雄，刘瑾，等.卡他莫拉菌临床分布及耐药性分析[J].中华医院感染学杂志，2014, 24(3):545-546.
[13]张莉萍，李贺扬，袁达康，等.东莞市12月~18月龄健康婴幼儿鼻咽部肺炎链球菌、流感嗜血杆菌及卡他莫拉菌携带状况调查[J].中国卫生检验杂志，2011, 21(2):496-498.
[2]孙燕，孔菁，张泓，等. 2005—2014年CHINET流感嗜血杆菌和卡他莫拉菌耐药性监测[J].中国感染与化疗杂志，2016,16(2):153-159.
[3]胡亚美，江载芳.诸福棠实用儿科学[M]. 7版.北京：人民卫生出版社，2002:462.
[4] Clinical and Laboratory Standards Institute. Methods for antimicrobial dilution and disk susceptibility testing of infrequently isolated or fastidious bacteria(M45)[S]. 3rd, 2015.
[5]孙慧明，周卫芳，季伟，等.苏州地区下呼吸道感染住院患儿卡他莫拉菌感染与气候因素相关性研究[J].临床儿科杂志，2014, 32(6):524-527.
[6]袁少伟，李慧.儿童呼吸道卡他莫拉菌感染分布及耐药分析[J].宁夏医学杂志，2014, 36(5):451-453.
[7]李振国，贵琳，黄洋，等.儿童卡他莫拉菌呼吸道感染的耐药性研究[J].中华医院感染学杂志，2016, 26(1):185-187.
[8]杨海娟，陈霞，吴佳辉，等.患儿呼吸道感染91例卡他莫拉菌及耐药性分析[J].陕西医学杂志，2015, 44(5):527-529.
[9]唐萍，史伟，曾海玲，等. 1082例呼吸道感染住院患儿鼻咽部携带卡他莫拉菌状况及其耐药性分析[J].中国当代儿科杂志，2016, 18(8):707-712.
[10] SPANIOL V, TROLLER R, AEBI C. Physiologic cold shock increases adherence of moraxella catarrhalis to and secretion of interleukin 8 in human upper respiratory tract epithelial cells[J]. J Infect Dis, 2009, 200(10):1593-1601.
[11] MORRISSEY I, MAHER K, WILLIAMS L, et al. Nonsusceptibility trends among Haemophilus influenzae and Moraxella catarrhalis from community-acquired respiratory tract infections in the UK and Ireland, 1999-2007[J]. J Antimicrob Chemother, 2008, 62(Suppl 2):ii97-103.
[12]张玲，程方雄，刘瑾，等.卡他莫拉菌临床分布及耐药性分析[J].中华医院感染学杂志，2014, 24(3):545-546.
[13]张莉萍，李贺扬，袁达康，等.东莞市12月~18月龄健康婴幼儿鼻咽部肺炎链球菌、流感嗜血杆菌及卡他莫拉菌携带状况调查[J].中国卫生检验杂志，2011, 21(2):496-498.