目的 了解呼吸道感染儿童鼻咽部卡他莫拉菌的携带情况及分离株对常见抗菌药物的敏感性。方法 采集1082例呼吸道感染患儿鼻咽拭子并分离卡他莫拉菌，采用E-test法和纸片扩散法检测菌株对11种常见抗菌药物的敏感性，结合3种判读标准解读检测结果。用头孢硝噻吩纸片法检测分离株是否产β-内酰胺酶。结果 1082例呼吸道感染患儿中，鼻咽部卡他莫拉菌携带率为7.12% （77/1082）。所有菌株均产β-内酰胺酶。无论使用哪种判读标准，所有菌株对阿莫西林-克拉维酸均敏感；对环丙沙星和四环素的敏感率>95.0%。根据EUCAST和CLSI标准，分离株对磺胺甲噁唑-甲氧苄啶的敏感率高达98.7%，对所检测的3种头孢菌素的敏感率均超过80%。但根据BSAC标准判读时，菌株对头孢呋辛的敏感率仅为2.6%，对氨苄西林耐药率为81.8%。依据CLSI判读时，分离株对红霉素的不敏感率为79.2%，根据EUCAST或BSAC判断时，其不敏感率高达90.9%，且超过三分之一的菌株 （27/77，35.1%） MIC值>256mg/L。结论 呼吸道感染患儿鼻咽部卡他莫拉菌分离株均产β-内酰胺酶，对阿莫西林-克拉维酸全部敏感，对第三代和第四代头孢菌素、磺胺甲噁唑-甲氧苄啶敏感率高，但多对氨苄青霉素、头孢呋辛和红霉素耐药。
Abstract
Objective To investigate the prevalence of Moraxella catarrhalis in the nasopharyngeal region of children with respiratory infection and the sensitivity of Moraxella catarrhalis isolates to common antimicrobial drugs. Methods Nasopharyngeal swabs were collected from 1082 children with respiratory infection, and Moraxella catarrhalis strains were isolated. The E-test method and disc diffusion test were used to determine the sensitivity of these strains to 11 common antimicrobial drugs. The test results were interpreted with reference to the standards of European Committee on Antimicrobial Susceptibility Testing (EUCAST), Clinical and Laboratory Standards Institute (CLSI), and British Society for Antimicrobial Chemotherapy (BSAC). The nitrocefin disc method was used to detect whether the isolated strains produced β-lactamase. Results Among the 1 082 children with respiratory infection, 77 (77/1082, 7.12%) carried Moraxella catarrhalis in the nasopharyngeal region. All the strains produced β-lactamase. With reference to all the three standards, all the strains were sensitive to amoxycillin-clavulanate and had a susceptibility rate of >95% towards ciprofloxacin and tetracycline. According to the EUCAST and CLSI standards, the susceptibility rate of the strains towards sulfamethoxazole-trimethoprim was as high as 98.7%, and more than 80% of all strains were sensitive to the three cephalosporins detected; however, with reference to the BSAC standard, only 2.6% of the strains were sensitive to cefuroxime, with an intermediate rate of 44.2% and a drug resistance rate of 53.2%. The rate of resistance to ampicillin was 81.8%. According to the CLSI standard, the non-susceptibility rate of the strains to erythromycin was 79.2%, and according to the EUCAST or BSAC standards, their non-susceptibility rate reached 90.9%; more than one third of the strains (27/77, 35.1%) had a minimal inhibitory concentration of >256 mg/L. Conclusions All of the Moraxella catarrhalis isolates in the nasopharyngeal region of children with respiratory infection produce β-lactamase and are sensitive to amoxycillin-clavulanate. These isolates have high susceptibility rates to the third- and fourth-generation cephalosporins and sulfamethoxazole-trimethoprim, but most of the isolates are resistant to ampicillin, cefuroxime, and erythromycin.
关键词
卡他莫拉菌 /
携带率 /
耐药性 /
儿童
Key words
Moraxella catarrhalis /
Prevalence /
Drug resistance /
Child
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参考文献
[1] Wang H,Chen M,Xu Y,et al.Antimicrobial susceptibility of bacterial pathogens associated with community-acquired respiratory tract infections in Asia:report from the Community-Acquired Respiratory Tract Infection Pathogen Surveillance (CARTIPS) STUDY,2009-2010[J].Int J Antimicrob Agents,2011,38(5):376-383.
[2] 漆坚.流感嗜血杆菌、肺炎链球菌和卡他莫拉菌的耐药性分析[J].实验与检验医学,2013,31(6):559-560.
[3] 张泓,孔菁,王传清,等.2010中国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,2012,12(3):180-184.
[4] Aebi C.Moraxella catarrhalis-pathogen or commensal?[J].Adv Exp Med Biol,2011,697:107-116.
[5] Morrissey I,Maher K,Williams L,et al.Non-susceptibility 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-ii103.
[6] Bandet T,Whitehead S,Blondel-Hill E,et al.Susceptibility of clinical Moraxella catarrhalis isolates in British Columbia to six empirically prescribed antibiotic agents[J].Can J Infect Dis Med Microbiol,2014,25(3):155-158.
[7] 潘韶霞,徐洪玉,潘韶华,等.卡他莫拉菌的致病性及耐药性的临床研究[J].中华医院感染学杂志,2003,13(6):583-585.
[8] 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.
[9] 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.
[10] Clinical and Laboratory Standards Institute (CLSI).Methods for Antimicrobial Dilution and Disk Susceptibility Testing of Infrequently Isolated or Fastidious Bacteria;Approved Guideline[S].M45-A,2014,26(19):28-29.
[11] Andrews JM;BSAC Working Party on Susceptibility Testing.BSAC standardized disc susceptibility testing method (version 8)[J].J Antimicrob Chemother,2009,64(3):454-489.
[12] 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.
[13] 车大钿,张泓,陆权,等.急性下呼吸道感染患儿卡他莫拉菌耐药性与bro基因分型研究[J].中国实用儿科杂志,2009,24(8):606-609.
[14] 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.
[15] 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.
[16] 王频佳,谢成彬,吴雨露.儿童呼吸道卡他莫拉菌分离株耐药性与BRO基因分型研究[J].临床儿科杂志,2013,31(8):719-722.
[17] 林爱心,谭南,杨晓华,等.997例卡他莫拉菌的分布情况及药物敏感性分析[J].国际检验医学杂志,2016,37(3):376-377.
[18] 罗宇鹏.住院儿童呼吸道标本病原菌分布及耐药性分析[J].现代临床医学,2016,42(1):52-54.
[19] Sheikh SO,Fasih N,Irfan S,et al.β-Lactamase production and antimicrobial susceptibility pattern of Moraxella catarrhalis isolates:report from Pakistan[J].Asian Pac J Trop Med,2014,7S1:S228-S231.
[20] 王艳,袁林,沈叙庄,等.北京地区呼吸道感染患儿卡他莫拉菌携带情况及耐药性分析[J].中国抗感染化疗杂志,2003,3(6):332-335.
[21] Abdullah FE,Ahuja KR,Kumar H.Prevalence and emerging resistance of Moraxella catarrhalis in lower respiratory tract infections in Karachi[J].J Pak Med Assoc,2013,63(11):1342-1344.
[22] Liu Y,Xu H,Xu Z,et al.High-level macrolide-resistant Moraxella catarrhalis and development of an allele-specific PCR assay for detection of 23S rRNA gene A2330T mutation:a three-year study at a Chinese tertiary hospital[J].Microb Drug Resist,2015,21(5):507-511.
[23] Iwata S,Sato Y,Toyonaga Y,et al.Genetic analysis of pediatric clinical isolate of Moraxella catarrhalis with resistance to macrolides and quinolones[J].J Infect Chemother,2015,21(4):308-311.
[24] Kasai A,Ogihara S,Yamada K,et al.Prevalence and molecular analysis of macrolide-resistant Moraxella catarrhalis isolates in Japan,following emergence of the highly macrolide-resistant strain NSH1 in 2011[J].J Med Microbiol,2015,64(7):708-713.
基金
国家科学技术部项目（2013BAI09B11）；北京市科委行业定额经费自主项目（2016-bjsekyjs-3）。
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