儿童A族β溶血性链球菌分离株抗生素耐药模式的研究  

Antibiotic resistant pattern of group A beta-hemolytic Streptococcus isolated from children

作　　者：冯利娟[1] 杨永弘[1] 俞桑洁[1] 姚开虎[1] 袁林[1] 沈叙庄[1] 

机构地区：[1]首都医科大学附属北京儿童医院儿科研究所微生物室,北京100045

出　　处：《中国感染与化疗杂志》2010年第2期127-130,共4页Chinese Journal of Infection and Chemotherapy

基　　金：国家863项目资助(2006AA02Z417)

摘　　要：目的了解我国儿科临床分离A族β溶血性链球菌对抗生素的耐药特点。方法选取2005—2008年5所不同地区儿童医院临床分离的A族β溶血性链球菌371株,对上述菌株进行药物敏感试验,采用PCR方法检测大环内酯类抗生素及四环素耐药基因。结果药敏试验结果显示,对大环内酯类药物耐药率高达94.0%以上,MIC50与MIC90均大于512mg/L;克林霉素、四环素和氯霉素耐药率分别为96.9%、90.6%和3.5%;对青霉素、左氧氟沙星和头孢他啶的敏感率则为100%。在371株分离菌中观察到6种耐药谱,其中以对大环内酯类抗生素、克林霉素、四环素联合耐药为主,占85.7%(316/378),其次为对大环内酯类抗生素和克林霉素耐药,占6.5%(24/371)。2007—2008年191株红霉素耐药株中,ermB阳性菌株占分离株总数的95.8%(183/191),ermTR4.2%(8/191),无mefA阳性株。tetM阳性株占91.1%(174/191),tetO阳性占0.5%(1/191)。结论我国儿科临床分离的A族β溶血性链球菌以耐大环内酯类抗生素、克林霉素和四环素为主,ermB和tetM耐药基因常同时存在。Objective To understand the different resistant patterns of clinical Streptococcus pyogenes isolates from children＇s hospitals in China to identify the prevalent resistant strains.Methods A total of 371 strains of Streptococcus pyogenes were collected from patients in 5 children＇s hospitals.The antimicrobial susceptibility was determined by agar dilution method.The genes encoding macrolide resistance and tetracycline resistance were amplified by PCR.Results In 371 strains of Group A Streptococcus,more than 94.0% were resistant to macrolide antibiotics.Both MIC50 and MIC90 values were ≥512 mg/L.The resistance rate to clindamycin,tetracycline and chloramphenicol was 96.9%,90.6%,and 3.5%,respectively.All the isolates were susceptible to penicillin,levofloxacin and ceftazidime.We found 6 different resistant patterns.The dominant pattern was concomitant resistance to macrolides,clindamycin and tetracyclines（85.7%,316/378）,followed by combined resistance to macrolide and clindamycin（6.5%,24/371）.These two patterns accounted for 90.6% of the isolates.Of the 191 strains of erythromycin-resistant Streptococcus isolated during 2007-2008,ErmB was identified in 95.8%（183/191）of the isolates,ermTR 4.2%（8/191）.mefA was not identified in any isolate.tetM gene was identified in 91.1%（174/191）and tetO in 0.5%（1/191）of the isolates.Conclusions The most common resistant pattern of group A Streptococcus in China is concomitant resistant to macrolides,clindamycin and tetracycline,which is usually mediated by both ermB and tetM.

关 键 词：A族Β溶血性链球菌 耐药谱 药敏试验 

分 类 号：R446.5[医药卫生—诊断学]