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目的 研究 2 0 0 1年春季北京和西安市部分 0～ 5岁急性上呼吸道感染儿童鼻咽部肺炎链球菌分离株对红霉素及新型大环内酯类抗生素耐药特性。方法 使用超细鼻咽拭子从后鼻腔采取分泌物 ,用Optochin纸片做敏感性试验鉴定。采用E test方法及K B纸片扩散法对 16 0株肺炎链球菌分别进行 5种大环内酯类、6种其它相关抗生素敏感性检测。结果 16 0株肺炎链球菌分离株中 ,90 6 %菌株的红霉素MIC等于或大于 1μg·mL-1为耐药株。在红霉素耐药的肺炎链球菌中 ,仅有 2 8%菌株的红霉素MIC在 1～ 4 μg·mL-1,为低水平耐药 ,97 2 %菌株的红霉素MIC在 16～≥ 2 5 6 μg·mL-1,为高水平耐药 ,其中 98 6 %耐药株的红霉素MIC≥ 2 5 6 μg·mL-1为极重度耐药。分离株对阿奇霉素、克拉霉素、罗红霉素、螺旋霉素耐药率与红霉素相似 ,分别为 90 6 %、89 4 %、88 1%和 88 1%。红霉素耐药表型分析显示 :以MLSB 耐药表型为主 ,占 97 2 % ;M耐药表型株仅为 2 8%。红霉素耐药分离株对克林达霉素、四环素、复方新诺明共同耐药率及多重耐药发生率分别为 96 6 %、97 2 %、85 6 %和 99 3% ,明显高于红霉素敏感组肺炎链球菌的 13 3%、73 3%、2 6 7%和 0。结论 北京和西安两地急性上呼吸道感染儿童鼻咽部肺炎链球菌分离株对红
Objective To study the drug resistance of erythromycin and new macrolide antibiotics to nasopharyngeal pneumococcal nasopharyngeal isolates from children with acute upper respiratory tract infection of 0 ~ 5 years old in Beijing and Xi’an in the spring of 2001. Methods Ultrafine nasopharyngeal swabs were used to take secretions from the posterior nasal cavity and tested for sensitivity using Optochin paper. Six strains of Streptococcus pneumoniae were tested for susceptibility to five macrolides and six other antibiotics using E test method and KB method. Results Among 160 isolates of Streptococcus pneumoniae, 90.6% of the isolates had erythromycin MIC equal to or greater than 1 μg · mL -1 as drug-resistant strains. In erythromycin-resistant Streptococcus pneumoniae, only 28% of the strains had erythromycin MICs between 1 and 4 μg · mL-1, with low levels of resistance, 97.2% of the strains had erythromycin MICs at 16 ~ ≥256 μg · mL-1, high level of drug resistance, of which 986% resistant strains of erythromycin MIC ≥ 25 6 μg · mL-1 was extremely resistant. The isolates were resistant to azithromycin, clarithromycin, roxithromycin and spiramycin with erythromycin resistance rates of 90.6%, 89.4%, 88.1% and 88.1%, respectively. The erythromycin resistance phenotype analysis showed that the MLSB resistance phenotype was predominant, accounting for 97.2%; M resistance phenotype was only 28%. The common and multiple drug resistance rates of erythromycin resistant isolates to clindamycin, tetracycline and cotrimoxazole were 96 6%, 97 2%, 85 6% and 99 3%, respectively, which were significantly higher 13 3%, 73 3%, 267%, and 0 of erythromycin-sensitive group of S. pneumoniae. Conclusion In Beijing and Xi’an, acute respiratory tract infection in children with nasopharyngeal Streptococcus pneumoniae isolates of red