2013～2017年海南医学院第二附属医院无乳链球菌的临床分布及耐药性分析
|
摘要
目的探讨无乳链球菌的临床分布和耐药性,为预防临床感染和指导临床合理用药提供依据。方法收集2013年1月~2017年12月海南医学院第二附属医院门诊及住院患者各类临床标本。采用WHONET 5.6软件统计分析无乳链球菌引起感染的类型和耐药性,并对红霉素耐药、克林霉素敏感或中介的无乳链球菌做D-抑菌圈试验。结果共检出无乳链球菌261株,检出率逐年呈上升趋势。其主要集中分布于妇产科、门诊和泌尿外科。主要来源于阴道分泌物,其次是清洁中段尿和伤口分泌物。无乳链球菌对青霉素、氨苄西林、万古霉素和利奈唑胺均未发现耐药株;对头孢噻肟、对头孢吡肟和头孢曲松的耐药率较低;而对克林霉素、红霉素、阿奇霉素、四环素耐药率较高。结论无乳链球菌感染最常见于泌尿生殖系统感染和软组织感染,青霉素和其他β-内酰胺类药物可作为无乳链球菌感染经验用药的首选药物。另外,加做D-抑菌圈试验可有效避免不合理使用克林霉素,并根据药敏试验结果合理选用抗菌药物进行预防与治疗。
Objective To investigate the clinical distribution and drug resistance of Streptococcus agalactiae, and to provide evidence for preventing clinical infection and guiding clinical rational drug use. Methods All kinds of clinical specimens were collected from outpatient and inpatient patients of the Second Affiliated Hospital of Hainan Medical College from January 2013 to December 2017. WHONET 5.6 software was used to statistically analyze the types of infection and drug resistance caused by Streptococcus agalactiae, and to conduct the D-Bacteriostatic circle test for Streptococcus agalactiae with Erythromycin resistance, Clindamycin sensitivity or intermediate. Results A total of 261 strains of Streptococcus agalactiae were detected, and the detection rate was increasing year by year. Mainly distributed in obstetrics and gynecology, outpatient and urology. Mainly from vaginal secretions, followed by cleaning midstream urine and wound secretions. No resistant strains to Penicillin, Ampicillin, Vancomycin and Linezolid were found. The drug resistance rates of Cefotaxime, Cefepime and Ceftriaxone were low. And Clindamycin, Erythromycin, Azithromycin,Tetracycline resistance rate were high. Conclusion Streptococcus agalactiae infections are most common in urinary and reproductive system infections and soft tissue infections, and Penicillin and other β-lactamides can be used as the first choice of empiric agents for Streptococcus agalactiae infections. In addition, the addition of D-circle test can effectively avoid the unreasonable use of Clindamycin, and according to the drug sensitivity test results, the rational selection of antimicrobial agents for prevention and treatment.
Objective To investigate the clinical distribution and drug resistance of Streptococcus agalactiae, and to provide evidence for preventing clinical infection and guiding clinical rational drug use. Methods All kinds of clinical specimens were collected from outpatient and inpatient patients of the Second Affiliated Hospital of Hainan Medical College from January 2013 to December 2017. WHONET 5.6 software was used to statistically analyze the types of infection and drug resistance caused by Streptococcus agalactiae, and to conduct the D-Bacteriostatic circle test for Streptococcus agalactiae with Erythromycin resistance, Clindamycin sensitivity or intermediate. Results A total of 261 strains of Streptococcus agalactiae were detected, and the detection rate was increasing year by year. Mainly distributed in obstetrics and gynecology, outpatient and urology. Mainly from vaginal secretions, followed by cleaning midstream urine and wound secretions. No resistant strains to Penicillin, Ampicillin, Vancomycin and Linezolid were found. The drug resistance rates of Cefotaxime, Cefepime and Ceftriaxone were low. And Clindamycin, Erythromycin, Azithromycin,Tetracycline resistance rate were high. Conclusion Streptococcus agalactiae infections are most common in urinary and reproductive system infections and soft tissue infections, and Penicillin and other β-lactamides can be used as the first choice of empiric agents for Streptococcus agalactiae infections. In addition, the addition of D-circle test can effectively avoid the unreasonable use of Clindamycin, and according to the drug sensitivity test results, the rational selection of antimicrobial agents for prevention and treatment.
引文
[1]Rogers LM,Gaddy JA,Manning SD,et al.Variation in macrophage phagocytosis of Streptococcus agalactiae does not reflect bacteria capsular serotype,multilocus sequence type,or association with invasive infection[J].Pathog Immun,2018,3(1):63-71.
[2]陈惠玲,叶惠芬,邓家德,等.B族链球菌皮肤软组织及创伤感染分离株的耐药基因检测[J].国际检验医学杂志,2010,31(10):1057-1058,1061.
[3]尚红,王毓三,申子瑜.全国临床检验操作规程[M].4版.北京:人民卫生出版,2015:629-647.
[4]Alhhazmi A,Hurteau D,Tyrrell GJ,et al.Epidemiology of invasive group B streptococcal disease in Alberta,Canada,from 2003 to 2013[J].J Clin Microbiol,2016,54(7):1774-1781.
[5]胡利春,邹洁洁,陈海燕.晚期孕妇生殖道感染无乳链球菌与新生儿感染的相关性研究[J].中国微生态学杂志,2014,26(7):836-838.
[6]胡付品,朱德妹,汪复,等.2013年中国CHINET细菌耐药性监测[J].中国感染与化疗杂志,2014,14(5):365-374.
[7]胡付品,朱德妹,汪复,等.2014年中国CHINET细菌耐药性监测[J].中国感染与化疗杂志,2015,15(5):401-410.
[8]胡付品,朱德妹,汪复,等.2015年中国CHINET细菌耐药性监测[J].中国感染与化疗杂志,2016,16(6):685-694.
[9]胡付品,郭燕,朱德妹,等.2016年中国CHINET细菌耐药性监测[J].中国感染与化疗杂志,2017,17(5):481-491.
[10]胡付品,郭燕,朱德妹,等.2017年中国CHINET细菌耐药性监测[J].中国感染与化疗杂志,2018,18(5):241-251.
[11]时春艳,杨慧霞.B族溶血性链球菌围产期感染的预防和处理策略[J].中国围产医学杂志,2008,11(5):315-318.
[12]Barcaite E,Bartusevicius A,Tameliene R,et al.Prevalence of maternal group B streptococcal colonisation in European countries[J].Acta Obstet Gynecol Scand,2008,87(3):260-271.
[13]林宇岚,陈守涛,荀振,等.179株无乳链球菌的标本分布及耐药性分析[J].国际检验医学杂志,2015,36(10):1376-1378.
[14]曹学萍,张贤华,陈慧芬,等.2015年至2017年上海地区无乳链球菌临床感染情况及耐药性分析[J].诊断学理论与实践,2018,17(3):308-310.
[15]李丽民,吴先华,徐礼锋.无乳链球菌的临床感染分布及耐药性分析[J].中华医院感染学杂志,2014,24(3):549-551.
[16]宋小华,应群华,楼秀敏.妊娠晚期孕妇无乳链球菌感染与耐药性变迁分析[J].中国卫生检验杂志,2017,27(9):1338-1340.
[17]彭捷,黄荣富,钟文.围产期孕妇泌尿生殖道无乳链球菌的感染与耐药性分析[J].中华医院感染学杂志,2017,27(8):1841-1844.
[18]张传飞.育龄妇女泌尿生殖道无乳链球菌感染情况与耐药性分析[J].中国微生态学杂志,2016,28(9):1094-1096.
[19]刘晶,吉彤珍,赵娟.孕妇感染B群无乳链球菌的耐药性分析[J].中国卫生检验杂志,2013,23(16):3298-3299.
[20]Church D,Carson J,Gregson D.Point prevalence study of antibiotic susceptibility of genital group B Streptococcus isolated from near-term pregnant women in Calgary,Alberta[J].Can J Infect Dis Med Microbiol,2012,23(3):121-124.
[21]Sheen TR,Jimenez A,Wang NY,et al.Serine-rich repeat proteins and pili promote Streptococcus agalactiae colonization of the vaginal tract[J].J Bacteriol,2011,193(24):6834-6842.
[22]陈东科,孙长贵.实用临床微生物学检验与图谱[M].北京:人民卫生出版社,2011:795-796.
[23]李娟,高坎坎,容莉莉,等.新生儿侵袭性感染B族链球菌的耐药表型及耐药机制[J].中华实验和临床感染病杂志:电子版,2018,12(1):20-27.
[2]陈惠玲,叶惠芬,邓家德,等.B族链球菌皮肤软组织及创伤感染分离株的耐药基因检测[J].国际检验医学杂志,2010,31(10):1057-1058,1061.
[3]尚红,王毓三,申子瑜.全国临床检验操作规程[M].4版.北京:人民卫生出版,2015:629-647.
[4]Alhhazmi A,Hurteau D,Tyrrell GJ,et al.Epidemiology of invasive group B streptococcal disease in Alberta,Canada,from 2003 to 2013[J].J Clin Microbiol,2016,54(7):1774-1781.
[5]胡利春,邹洁洁,陈海燕.晚期孕妇生殖道感染无乳链球菌与新生儿感染的相关性研究[J].中国微生态学杂志,2014,26(7):836-838.
[6]胡付品,朱德妹,汪复,等.2013年中国CHINET细菌耐药性监测[J].中国感染与化疗杂志,2014,14(5):365-374.
[7]胡付品,朱德妹,汪复,等.2014年中国CHINET细菌耐药性监测[J].中国感染与化疗杂志,2015,15(5):401-410.
[8]胡付品,朱德妹,汪复,等.2015年中国CHINET细菌耐药性监测[J].中国感染与化疗杂志,2016,16(6):685-694.
[9]胡付品,郭燕,朱德妹,等.2016年中国CHINET细菌耐药性监测[J].中国感染与化疗杂志,2017,17(5):481-491.
[10]胡付品,郭燕,朱德妹,等.2017年中国CHINET细菌耐药性监测[J].中国感染与化疗杂志,2018,18(5):241-251.
[11]时春艳,杨慧霞.B族溶血性链球菌围产期感染的预防和处理策略[J].中国围产医学杂志,2008,11(5):315-318.
[12]Barcaite E,Bartusevicius A,Tameliene R,et al.Prevalence of maternal group B streptococcal colonisation in European countries[J].Acta Obstet Gynecol Scand,2008,87(3):260-271.
[13]林宇岚,陈守涛,荀振,等.179株无乳链球菌的标本分布及耐药性分析[J].国际检验医学杂志,2015,36(10):1376-1378.
[14]曹学萍,张贤华,陈慧芬,等.2015年至2017年上海地区无乳链球菌临床感染情况及耐药性分析[J].诊断学理论与实践,2018,17(3):308-310.
[15]李丽民,吴先华,徐礼锋.无乳链球菌的临床感染分布及耐药性分析[J].中华医院感染学杂志,2014,24(3):549-551.
[16]宋小华,应群华,楼秀敏.妊娠晚期孕妇无乳链球菌感染与耐药性变迁分析[J].中国卫生检验杂志,2017,27(9):1338-1340.
[17]彭捷,黄荣富,钟文.围产期孕妇泌尿生殖道无乳链球菌的感染与耐药性分析[J].中华医院感染学杂志,2017,27(8):1841-1844.
[18]张传飞.育龄妇女泌尿生殖道无乳链球菌感染情况与耐药性分析[J].中国微生态学杂志,2016,28(9):1094-1096.
[19]刘晶,吉彤珍,赵娟.孕妇感染B群无乳链球菌的耐药性分析[J].中国卫生检验杂志,2013,23(16):3298-3299.
[20]Church D,Carson J,Gregson D.Point prevalence study of antibiotic susceptibility of genital group B Streptococcus isolated from near-term pregnant women in Calgary,Alberta[J].Can J Infect Dis Med Microbiol,2012,23(3):121-124.
[21]Sheen TR,Jimenez A,Wang NY,et al.Serine-rich repeat proteins and pili promote Streptococcus agalactiae colonization of the vaginal tract[J].J Bacteriol,2011,193(24):6834-6842.
[22]陈东科,孙长贵.实用临床微生物学检验与图谱[M].北京:人民卫生出版社,2011:795-796.
[23]李娟,高坎坎,容莉莉,等.新生儿侵袭性感染B族链球菌的耐药表型及耐药机制[J].中华实验和临床感染病杂志:电子版,2018,12(1):20-27.