D-实验检测葡萄球菌中诱导型克林霉素耐药的实验研究  

Study of Using the D Test Method for Detection for Inducible Clindamycin Resistance of Staphylococcus Isolates and Analysis of Resistance

作　　者：耿燕[1] 王香玲[1] 赵丽华[1] 刘军[1] 张毅[1] 高宁[1] 

机构地区：[1]西安交通大学第二医院检验科,陕西西安710004

出　　处：《现代检验医学杂志》2007年第3期54-56,共3页Journal of Modern Laboratory Medicine

摘　　要：目的了解西安地区葡萄球菌对红霉素和克林霉素的不同耐药表型及其诱导型克林霉素耐药的发生率。方法采用K-B法检测葡萄球菌对红霉素和克林霉素的耐药性,头孢西丁纸片扩散法检测耐甲氧西林葡萄球菌,D试验检测诱导型克林霉素耐药表型。结果所有204株葡萄球菌中,90株(44.12%)为结构型耐药(cM LS),即对红霉素和克林霉素同时耐药;57株(27.94%)为诱导型耐药(iM LS),即对红霉素耐药对克林霉素敏感,但D试验阳性;32株(15.69%)为M S表型,即对红霉素耐药,对克林霉素敏感,但D试验阴性(M S);其中在红霉素耐药、克林霉素敏感体外表型中,显示诱导型克林霉素耐药在M RSA,M SSA,M RCN S和M SCN S中的比例分别为65.22%,58.33%,67.65%和60%;在所有耐红霉素菌株所占比例分别为31.25%,36.84%,31.94%和30%。结论西安地区耐红霉素葡萄球菌中诱导型克林霉素耐药的发生率处于相对较高水平,临床细菌室应重视D-试验以指导临床合理选择抗生素。Objective To investigate the resistant phenotype of erythromycin and clindamycin against staphylococcus and the prevalence of inducible clindamycin resistant in erythromycin-resistant staphylococcus in the local district. Methods Kirby- Bauer method was performed to detect the resistance of erythromycin and cllndamycin against staphylococcus,cefoxitin disk diffusion method and D-test suggested by NCCLS 2004 guidelines were used to detect methicillin-resistant staphylococcus （MRS） and the inducible clindamycin resistant in erythromycin-resistant staphylococcus. Results Of all 204 staphylococcus strains 90 （44.12% ） were resistant to both erythromycin and clindamycin（cMLS） constitutive resistance to clindamycin, 57 （27.94%） were resistant to erythromycin but susceptible to clindamycin and showed positive D test results （iMLS）;32 （15.69 % ） were resistant to erythromycin but susceptible to clindamycin and showed negative D test results （MS）. Among the phenotype of resistant to erythromycin but susceptible to clindamycin the rates of inducible clindamycin-resistant of MRSA, MSSA, MRCNS and MSCNS were 65. 22%, 58. 33%, 67. 65%o and 60% respectively; Among all isolates erythromycin-resistant,the rates of inducible clindamycin-resistant were 31.25 %, 36.84 %, 31.94 % and 30% . Conclusion The percentage of inducible clindamycin-resistance was 53. 8%（35 /65） in clindamycin-susceptible staphylococcus isolates. The results indicated that D-test should be performed in clindamycin-susceptible isolates which were failing in clinical therapy by using clindamycin for staphylococcal infection. The detection of inducible clindamycin resistance must be stressed in clinical microbiology laboratory to provide good support for rational antibiotic therapy.

关 键 词：D-试验 葡萄球菌 克林霉素 红霉素 耐药性 

分 类 号：R378.11[医药卫生—病原生物学] R969.3[医药卫生—基础医学]