下呼吸道分离葡萄球菌对万古霉素异质性耐药  

Heterogeneous Resistance Staphylococcus to Vancomycin Isolated from the Lower Respiratory Tract

作　　者：吴本权[1] 唐英春[1] 张扣兴[1] 张天托[1] 朱家馨[1] 谈淑卿[1] 

机构地区：[1]中山大学附属第三医院内科,广东广州510630

出　　处：《中山大学学报（医学科学版）》2004年第5期474-477,共4页Journal of Sun Yat-Sen University:Medical Sciences

基　　金：罗氏感染研究青年医师基金资助项目(2001)

摘　　要：【目的】探讨万古霉素体外敏感,体内治疗失败的原因。【方法】选择本实验室1997年至1999年下呼吸道分离的115株耐甲氧西林葡萄球菌,用美国临床实验室标准委员会推荐的M-H琼脂板稀释法测定对万古霉素的敏感性;脑心浸液琼脂诱导对万古霉素异质性耐药株,用生物梅里埃公司APIStaph系统鉴定菌型;进一步用E-Test试条检测万古霉素敏感性。【结果】115株耐甲氧西林葡萄球菌对万古霉素敏感性下降34株(MIC>4mg/L):金黄色葡萄球菌13株,溶血葡萄球菌7株,松鼠葡萄球菌7株,表皮葡萄球菌3株,人葡萄球菌3株,产色葡萄球菌1株。万古霉素高度异质性耐药9株:金黄色葡萄球菌3株,溶血葡萄球菌6株;E-Test拭条在脑心浸液琼脂板中万古霉素异质性耐药葡萄球菌显示双重抑菌环。【结论】对万古霉素异质性耐药可能是万古霉素治疗医院内耐甲氧西林葡萄球菌感染失败的重要原因之一。To isolate heterogeneous resistance staphylococcus to vancomycin from the lower respiratory tract to probe what contribute to the failure of vancom ycin in vivo,even though sensitivity in vitro,in treating methicillin resistant staphylococcus infections.A total of 115strains of methicillin resistant staphylococci isolated from the lower respiratory tract from 1997to 1999in our laboratory were selected for detecting the susceptibility to vancomycin by the Mullen Hinton agar plate dilution re ference to National Committee for Cl inical Laboratory Standards.The heterogeneous resistance of sta phylococci reduced the susceptibility to vancomycin were induced on the brain heart infusion(BHI )agar plate.Heterogeneous resistan ce staphylococci were identified and typed by means of API Staph system and their resistance were further te sted by E-Test.Thirty-four methicillin resistant staphylococcus aureus with reduced susceptibility to vancomycin(MIC>4mg /L)had 13staphylococcus aureus,7stap hylococcus haemolyticus,7staphylococcus sciuri,3staphylococcus epidermidis,3stap hylococcus hominis,1staphylococcus chomogenes and 9high heterogeneous resistant staphyloc occi to vancomycin with 3staphylococcus aureus and 6staphylococcus haemolyticus.MIC o f vancomycin to staphylococcus on th e BHI were 2～4times as high as that of the M-H.It showed that BHI easily induced the heterogeneou sly resistant staphylococcus.[Conclusions]The heterogeneously resistant stap hylococci to vancomycin may be a significant cause of the failure of vancomycin in the treatment of methi cillin-resistant staphylococcus infections.

关 键 词：万古霉素 耐药 溶血葡萄球菌 下呼吸道 异质性 耐甲氧西林葡萄球菌 脑心 琼脂板 松鼠 生物 

分 类 号：R378[医药卫生—病原生物学] R978[医药卫生—基础医学]