中华皮肤科杂志 ›› 2000, Vol. 33 ›› Issue (6): 389-391.

• 论著 • 上一篇    下一篇

脓疱疮的病原菌分离及耐药性分析

马琳, 赵佩云, 杨永弘, 袁林, 佟月娟   

  1. 首都医科大学附属北京儿童医院皮肤科 北京 100045
  • 收稿日期:1999-12-09 出版日期:2000-12-15 发布日期:2000-12-15

The Study of Microbiology and Antibiotic Susceptibility of Bacterial Strains Isolated From Patients with Impetigo

MA Lin, ZHAO Peiyun, YANG Yonghong   

  1. Beijing Children's Hospital, Capital University of Medical Sciences, Beijing 100045
  • Received:1999-12-09 Online:2000-12-15 Published:2000-12-15

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摘要： 目的 观察脓疱疮的病原菌分布,监测耐药菌尤其是耐甲氧西林金黄色葡萄球菌的流行情况,为临床选择合理而有效的治疗方案提供依据。方法 对246例脓疱疮患者皮损进行病原菌分离,并对分离出的212株金黄色葡萄球菌(简称金葡菌)进行15种抗生素的琼脂稀释法药敏试验。结果 从246例脓疱疮患者皮损分离出病原菌233株,单纯金葡菌占87.0%;单纯A组β-溶血性链球菌占1.6%;金葡菌与A组β-溶血性链球菌混合感染占2.0%;表皮葡萄球菌占4.1%。对212株金葡菌进行的药敏试验结果显示,金葡菌对青霉素100%耐药,对红霉素为87.7%,对克林霉素为75.5%,对四环素、氯霉素、优力欣、苯唑西林、环丙沙星耐药率依次为63.2%、54.2%、44.8%、30.2%和12.8%,对头孢噻肟、夫西地酸、庆大霉素均为0.9%耐药,对头孢唑啉、头孢呋辛、莫匹罗星、万古霉素均未发现耐药菌。从212株金葡菌分离出64株耐甲氧西林金葡菌,未发现耐万古霉素菌株。结论 青霉素、红霉素、克林霉素、四环素、氯霉素和优力欣等种类的药物在本地区已不适于治疗金葡菌感染的脓疱疮。莫匹罗星、夫西地酸和头孢菌素可以作为治疗脓疱疮的局部或全身用药。

关键词: 脓疱疮, 葡萄球菌, 金黄色, 表皮, 链球菌属, 药物耐受性

Abstract: Objective To investigate the bacteriological features and the epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) in patients with impetigo, and provide evidence for selection of appropriate agents for treating impetigo and its complications. Methods Two hundred and forty-six out-patients with impetigo were surveyed. Cultures were obtained from impetiginous lesions. Antibiotic susceptibility tests on 212 S.aureus isolates were performed by standard agar dilution testing (MIC). Results In a total of 246 isolates, 87.0% yielded S.aureus alone, 2.0% S.aureus and Group A beta-hemolytic streptococcus (GABHS), 1.6% GABHS alone, 4.1% Staphylococcus epidermidis. Fifteen antimicrobial agents were used in the susceptibility tests. One hundred percent of S. aureus isolates were resistant to penicillin, 87.7% were resistant to erythromycin, followed by clindamycin (75.5%), tetracycline (63.2%), chloramphenicol (54.2%), ampicillin-sulbactam (44.8%), oxacillin (30.2%), ciprofloxacin (12.8%), cefotaxime (0.9%), fusidic acid (0.9%) and gentamicin (0.9%). None of the S.aureus isolates was resistant to vancomycin, cefazolin, cefuroxime and mupirocin. Sixty-four MRSA strains were isolated. No vancomycin resistant S.aureus strain was found. Conclusions Penicillin, erythromycin, clindamycin, tetracycline, chloramphenicol and ampicillin-sulbactam prove to be no longer the appropriate therapeutic agents. Cephalosporin, mupirocin and fusidic acid might be the good choice for treatment of impetigo in our region.

Key words: Impetigo sores, Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus, Drug tolerance