摘要目的了解北京地区儿童鼻部携带的肺炎链球菌对抗生素的敏感性以及血清型分布,分析鼻部携带青霉素非敏感肺炎链球菌的危险因素.方法用纸片扩散法检测肺炎链球菌对红霉素,复方新诺明,氯霉素和四环素的敏感性;E-试验确定青霉素,头孢呋新,头孢噻肟,安灭菌和亚胺培南的最小抑菌浓度;Quellung反应确定肺炎链球菌的血清型.结果未发现对青霉素和头孢呋新高度耐药的肺炎链球菌,但对青霉素和头孢呋新中度耐药的肺炎链球菌分别占8.2%和2.1%.所有菌株均对头孢噻肟,安灭菌和亚胺培南敏感.对红霉素,复方新诺明和四环素耐药的肺炎链球菌特别多,分别占72%70%和79%.所有肺炎链球菌中,有5种血清型(19,6,14,23,17)共占54.7%,不定型占20.6%.既往中耳炎病史是鼻部携带青霉素非敏感肺炎链球菌的危险因素.结论连续监测肺炎链球菌对抗生素的敏感性具有重要意义.需要进行更大规模的研究以明确目前的7价或9价肺炎链球菌结合疫苗是否适合中国儿童.

abstractsObjective To investigate the antimicrobial susceptibility of Streptococcus pneumoniae carried in the nose among children in Beijing and the distribution of serotypes,and to analyze the risk factors for nasal carriage of penicillin non-susceptible S.pneumoniae.Methods A disk diffusion test was applied to detect the antimicrobial susceptibilities of S.pneumoniae to erythromycin,trimethoprim-sulfamethoxazole,chloramphenicol and tetracycline.The E test was applied to determine the minimal inhibitory concentrations of penicillin,cefuroxime,cefotaxime,augmentin and imipenem.S.pneumoniae isolates were serotyped by the Quellung reaction.Results S.pneumoniae that was resistant to penicillin or cefuroxime was not found,but S.pneumoniae intermediate resistant to penicillin and cefuroxime accounted for 8.2% and 2.1%,respectively.All of the isolates were susceptible to cefotaxime,augmentin and imipenem.S.pneumonia that was resistant to erythromycin,trimethoprim-sulfamethoxazole and tetracycline were extremely numerous,accounting for 72%,70% and 79%,respectively.Five serotypes(19,6,14,23,17)accounted for 54.7%,and nontypables accounted for 20.6% of all the S.pneumoniae.Previous history of otitis media was a risk factor we found for nasal carriage of penicillin non-susceptible S.pneumoniae.Conclusions Continued surveillance of the antimicrobial susceptibilities of S.pneumoniae is necessary.A larger scale investigation is needed to identify if the 7 or 9-valent conjugate pneumococcal vaccine is appropriate for Chinese children.