流感嗜血杆菌阳性住院患儿回顾性流行病学调查

Epidemiological survey of Haemophilus influenzae-positive hospitalized children:a retrospective analysis

摘要:

目的 研究住院患儿流感嗜血杆菌(Hi)感染的基本临床特征及耐药动态。方法 回顾性断面调查2011 年6 月至2013 年5 月间成都市第三人民医院0~17 岁住院患儿痰液和咽拭子Hi 分离情况。结果 共分离出Hi 117 株, 111 例患儿纳入调查, 其中102 例为呼吸系统感染(91.9%), 其他疾病9 例(8.1%)。支气管肺炎及肺炎患儿Hi 检出率为50.8%(30/59), 急性喉气管支气管炎50.0%(2/4), 毛细支气管炎34.6%(9/26), 急性支气管炎24.2%(32/132), 喘息性支气管炎17.9%(5/28), 疱疹性咽峡炎19.0%(4/21), 急性上呼吸道感染11.8%(9/76), 急性扁桃体炎8.2%(7/85), 新生儿肺炎5.6%(3/54)。两个调查年度间阿莫西林克拉维酸(15% vs 23%, P=0.010)和氯霉素(25% vs 8%, P=0.015)耐药率差异有统计学意义。β- 内酰胺酶阴性氨苄西林耐药菌株(BLNAR)和β- 内酰胺酶阳性阿莫西林克拉维酸耐药菌株(BLPACR)两年间均有增长, 分别从12% 增加到21%, 13% 增加到19%, 但差异未达统计学意义(P>0.05)。结论 Hi 在0~17 岁儿童呼吸道感染中扮演着重要角色;BLNAR 和BLPACR 呈增长趋势将使临床面临更加严峻的抗菌素选择压力。

Abstract:

Objective To investigate the basic clinical characteristics and drug resistance of Haemophilus influenzae (Hi) infection in hospitalized children in the past two years. Methods A retrospective cross-sectional study was conducted to analyze Hi strains isolated from the sputum and pharyngeal swabs of children aged 0-17 years who were hospitalized in the Third People's Hospital of Chengdu between June 2011 and May 2013. Results A total of 117 strains were isolated from 111 hospitalized children. There were 102 cases (91.9%) of respiratory infection and 9 cases (8.1%) of other diseases. The positive rates of Hi in children with bronchopneumonia or pneumonia (50.8%, 30/59) and in children with acute laryngotracheobronchitis (50.0%, 2/4) were relatively high, followed by in children with capillary bronchitis (34.6%, 9/26), in children with acute bronchitis (24.2%, 32/132), in children with herpangina (19.0%, 4/21), in children with asthmatoid bronchitis (17.9%, 5/28), in children with acute upper respiratory tract infection (11.8%, 9/76), in children with acute tonsillitis (8.2%, 7/85), and in children with neonatal pneumonia (5.6%, 3/54). There were significant differences in the rates of resistance to amoxicillin-clavulanate (15% vs 23%; P=0.010) and chloramphenicol (25% vs 8%; P=0.015) between the two survey years. The frequencice of β-lactamase-nonproducing-ampicillin-resistant (BLNAR) strains and β-lactamase-producing-amoxicilli/clavulanate-resistant (BLPACR) strains increased from 12% to 21% and from 13% to 19% respectively during the two survey years (P>0.05). Conclusions Hi plays an important role in the respiratory tract infection of children aged 0-17 years. The increasing trend of BLNAR and BLPACR rates makes it harder for antibiotic selection in clinical practice.