临床分离流感嗜血杆菌和副流感嗜血杆菌的耐药性研究  

Resistance profiles of Haemophilus influenzae and Haemophilus parainfluenzae isolates in Shanghai

作　　者：袁瑾懿[1] 杨帆[1] 徐晓刚[1] 叶信予[1] 胡付品[1] 朱德妹[1] 

机构地区：[1]复旦大学附属华山医院抗生素研究所,上海200040

出　　处：《中华传染病杂志》2009年第5期262-267,共6页Chinese Journal of Infectious Diseases

摘　　要：目的了解上海部分医院分离的流感和副流感嗜血杆菌对常用抗菌药物的敏感性、对β内酰胺类和喹诺酮类药物的耐药机制以及耐药菌株的克隆传播情况。方法以琼脂稀释法测定氨苄西林等13种抗菌药物对2006年上海5所医院临床分离的156株嗜血杆菌属细菌的体外抗菌活性，头孢硝噻吩纸片法检测β-内酰胺酶，PCR扩增检测TEM和ROB型β-内酰胺酶基因和喹诺酮类耐药株的喹诺酮耐药决定区，以肠杆菌科基因间重复序列聚合酶链反应（ERICPCR）比较细菌的同源性。药物敏感性试验结果采用x^2检验，ERIC—PCR条带模型转换数据进行聚类分析。结果109株流感嗜血杆菌对氨苄西林敏感率为74．3％，而对氨苄西林-舒巴坦、头孢菌素类、氟喹诺酮类等敏感率为100．0％。109株流感嗜血杆菌和47株副流感嗜血杆菌β-内酰胺酶产酶率分别为25．7％和19．1%（x^2=0．776，P=0．378），产酶株均检测到TEM基因。109株流感嗜血杆菌中仅1株对环丙沙星耐药，其gyrA基因存在84位丝氨酸突变为亮氨酸，parC基因存在206位甘氨酸突变为精氨酸。ERIC—PCR结果显示，106株流感嗜血杆菌在85％相似度水平可被分为73型。结论上海地区流感嗜血杆菌临床菌株对除氨苄西林外的其他常用抗菌药物仍保持很高的敏感率。受试流感嗜血杆菌对氨苄西林耐药的主要机制均为产TEM型β-内酰胺酶。在包括氨苄西林耐药株在内的流感嗜血杆菌中，克隆传播尚不普遍。Objective To understand drug susceptibilities to common antibacterials, resistance mechanism to β-lactams and quinolones and the clonal spread of resistant stains of Haemophilus influenzae （ H. influenzae） and Haemophilus parain fluenzae （ H. parainfluenzae） isolated from some hospitals in Shanghai. Methods The in vitro antimicrobial susceptibilities to 13 antibacterials, such as ampieillin, of 156 Haemophilus strains collected from 5 hospitals of Shanghai in 2006 were tested by agar dilution method. The β-1aetamase production was determined by chromogenic cephalosporin test. TEM and ROB type of β- lactamase genes and quinolone resistance determining regions （QRDR） of ciprofloxaein-resistant strains were detected by polymerase chain reaction （PCR） amplification. The homology of H. influenzae strains were analyzed by enterobacterial repetitive intergenic consensus （ERIC）-PCR. Results The susceptible rate of 109 strains H. influenzae to ampicillin was 74.3 %, while those to ampicillin-sulbactam, cephalosporins and fluoroquinolones were all 100.0%. The β-lactamase-producing rates of 109 strains H. influenzae and 47 2 strains H. parainfluenzae were 25.7% and 19.1% （x^2 =0. 776,P=0. 378）, respectively. TEM gene was detected in all β-lactamases-producing strains. Of 109 H. influenzae isolates, only one was resistant to ciprofloxacin, and Ser84Leu mutation was detected in g yrA gene and Gly206Arg mutation in parC gene. The results of ERIC-PCR showed that 106 H. influenzae strains were clustered into 73 groups with similarity level of 85 %. Conclusions Clinical isolates of H. influenzae from hospitals in Shanghai remain highly susceptible to common antimicrobial agents except ampicillin. TEM type of β-lactamase production is the main ampicillin-resistant mechanism of the tested stains. The clonal spread of H. influenzae, including ampicillin-resistant strains, is not prevalent.

关 键 词：嗜血菌 流感 嗜血菌 副流感 Β内酰胺酶类 喹诺酮类 微生物敏感性试验 氨苄 西林 突变 基因 

分 类 号：R686[医药卫生—骨科学]