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目的了解流感嗜血杆菌(haemophilus influenza,HI)患儿分离株的耐药模式及流行特点,为临床经验治疗提供依据。方法 2007年1月至2014年12月浙江大学医学院附属儿童医院共检出HI菌株546株,98.7%的菌株来自呼吸道标本。男性患儿检出348株,女性198株,男女比例1.76∶1。年龄范围为7 d至13岁。HI培养采用嗜血杆菌专用培养基,菌株的鉴定采用Ⅴ因子和Ⅹ因子需求试验,药敏试验采用纸片扩散法,β内酰胺酶检测采用Cefinase纸片法。结果季节分布以春季为主,共331株(60.6%),秋季最少,仅23株(4.2%)。146株(26.7%)菌株β内酰胺酶阳性,菌株β内酰胺酶阳性率逐年上升。153株(28.0%)菌株对氨苄西林耐药。多重耐药株占60株(11.0%),最常见者为同时耐氨苄西林、复方磺胺甲恶唑和克拉霉素,β内酰胺酶阳性菌株多重耐药率显著高于阴性菌株(χ2=145.1,P<0.005)。结论浙江大学医学院附属儿童医院HI株主要来自呼吸道标本,感染患儿以1岁以内为主,每年2—5月为感染高峰季节,菌株对氨苄西林的耐药性有逐年上升趋势,对二代头孢菌素仍保持较高敏感性,其可作为经验治疗首先药物。
Objective To investigate the drug resistance patterns and epidemic characteristics of isolates from children with haemophilus influenza (HI) and provide basis for clinical experience. Methods From January 2007 to December 2014, 546 strains of HI were detected in Children’s Hospital affiliated to Zhejiang University School of Medicine, and 98.7% strains were from respiratory tract specimens. There were 348 males and 198 females, with a male / female ratio of 1.76: 1. The age range is 7 d to 13 years old. HI culture using Haemophilus specific medium, strain identification using factor V and factor X requirements test, susceptibility testing using disk diffusion method, beta lactamase detection using Cefinase paper method. Results The seasonal distribution was mainly in spring with a total of 331 plants (60.6%) and the lowest in autumn with only 23 plants (4.2%). Of 146 strains (26.7%), strains were positive for beta-lactamase, and the positive rate of beta-lactamase was increased year by year. 153 (28.0%) strains were resistant to ampicillin. Multi-resistant strains accounted for 60 (11.0%), the most common were resistant to ampicillin, sulfamethoxazole and clarithromycin compound, β-lactamase-positive strains were significantly higher than the negative multi-drug resistance rate (χ2 = 145.1 , P <0.005). Conclusion The HI strains of Children’s Hospital Affiliated to Zhejiang University Medical College mainly come from the respiratory tract specimens. The infected children are mostly within 1 year of age, and the peak season of infection is from February to May each year. The resistance of strains to ampicillin increases year by year, Aces cephalosporins still maintain a high sensitivity, which can be used as the first empirical treatment of drugs.