检测金黄色葡萄球菌诱导型克林霉素耐药的两种方法比较  

Utility of D test versus microdilution method in detecting inducible clindamycin resistance in Staphylococcus aureus

作　　者：邹明祥[1] 武文君[1] 曾娇辉[1] 梁伟 邬靖敏[1] 刘文恩[1] 范学工[1] 

机构地区：[1]中南大学湘雅医院检验科,长沙410008 [2]长沙市第三人民医院

出　　处：《中国感染与化疗杂志》2011年第2期147-150,共4页Chinese Journal of Infection and Chemotherapy

基　　金：湖南省自然科学基金资助(NO:10JJ5027)

摘　　要：目的了解临床分离金葡菌的耐药性及诱导型克林霉素耐药的发生率,评价微量肉汤稀释法检测诱导型克林霉素耐药的临床应用价值。方法 VITEK-2微生物分析系统及K-B法药敏试验对临床分离菌株进行鉴定和药物敏感性测定;红霉素和克林霉素双纸片扩散法和微量肉汤稀释法检测诱导型克林霉素耐药,并比较检测结果。结果受试的23种抗菌药物中,耐药率大于50.0%的药物品种达14种。其中,对青霉素和氨苄西林的耐药率最高,均为97.0%;其次对红霉素和四环素的耐药率分别为71.7%和68.7%;对替考拉宁、万古霉素和利奈唑胺的敏感率最高,均为100%;其次对呋喃妥因、氯霉素和磺胺甲口恶唑-甲氧苄啶的敏感率分别为95.0%、93.9%和88.9%。MRSA和MSSA各为63株(63.6%)和36株(36.4%)。对红霉素耐药和克林霉素敏感的菌株共10株,且D试验均为阳性,占所有菌株的10.1%。所有D试验阳性菌株微量肉汤稀释法也均为阳性,两者符合率为100%。结论临床分离金葡菌多重耐药现象十分严重。D试验和微量肉汤稀释法均可用于检测金葡菌诱导型克林霉素耐药。Objective To investigate the antibiotic resistance and prevalence of inducible clindamycin resistance in clinical isolates of Staphylococcus aureus. D test was compared with microdilution method in detecting the inducible clindamycin resistance in S. aureus. Methods Bacteria identification and susceptibility testing were performed by V1TEK-2 system and Kirby-Bauer disk method. The inducible clindamycin resistance was determined by D test with the combination of erythromycin （ERY） and clindamycin （CL） （ERY and CL at 4 and 0.5 mg/L respectively） and microdilution technique in a single well of broth microdilution panel. Results The resistance rate of the S. aureus isolates was higher than 50% to 14 of the 23 antibiotics tested. The highest resistance （both 97.0%） was to penicillin and ampicillin, followed by erythromycin and tetracycline （71.7% and 68.7% resistant）. All isolates were susceptible to teicoplanin, vancomycin and linezolid. The percentage of S. aureus isolates susceptible to nitrofurantoin, chloramphenicol and trimethoprim-sulfamethoxazole was 95. 0%, 93.9% and 88.9% respectively. The prevalence of methicillin resistant S. aureus （MRSA） and methicillinsensitive S. aureus （MSSA） in the 99 isolates was 63.6 % and 36.4%, respectively. Ten （10.1% ） of the 99 isolates showed resistant to erythromycin but susceptible to clindamycin. All the 10 isolates showed inducible resistance to clindamycin. The broth microdilution method performed identically with D test. Conclusions Resistance of S. aureus is quite serious. Both D test and microdilution methods can be used to detect the inducible clindamycin resistance in S. aureus.

关 键 词：金黄色葡萄球菌 耐药性 D试验 微量肉汤稀释法 诱导型耐药 

分 类 号：R446.5[医药卫生—诊断学]