成人耐大环内酯类抗生素肺炎链球菌的实验研究  

Laboratory investigation of the macrolide-resistant Streptococcus pneumoniae strains isolated from adults

作　　者：康悦[1] 吴菊芳[1] 徐晓刚[1] 叶信予[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：《中国感染与化疗杂志》2012年第1期54-58,共5页Chinese Journal of Infection and Chemotherapy

摘　　要：目的了解近年我国成人患者中分离的肺炎链球菌的耐药现状,为社区获得性呼吸道感染的抗菌药物选用提供依据。方法对临床明确诊断为社区获得性肺炎(CAP)及慢性气管炎急性加重(AECB)患者中分离获得肺炎链球菌;采用微量稀释法测定15种常用抗菌药物对肺炎链球菌的体外药敏结果;进行克林霉素诱导耐药性D试验;PCR扩增方法检测耐药基因。结果 71株肺炎链球菌中,青霉素敏感肺炎链球菌(PSSP)70株(70/71),占98.6%,青霉素中介肺炎链球菌(PISP)1株(1/70),占1.4%。大环内酯类抗生素耐药肺炎链球菌(MRSP)60株(60/71),占84.5%,MRSP中以cMLSB型耐药的菌株为主,有54株,占90%,其次为iMLSB型,占8.3%(5/60),1株为M型,占1.7%(1/60)。60株MRSP中ermB基因阳性检出率最高,占98.3%(59/60)。结论我国成人引起社区获得性呼吸道感染的肺炎链球菌对大环内酯类抗生素的耐药率高,大环内酯类抗生素在CAP治疗中可依据体外药敏试验结果选用,并需与β内酰胺类抗生素联合应用。Objective To investigate the resistance profile of S. pneumoniae strains isolated from adults in China and provide useful information for rational treatment of community acquired respiratory tract infections. Methods S. pneumoniae strains were isolated from adults with confirmed community-acquired pneumonia or acute exacerbation of chronic bronchitis. Microdilution method was used to test the sensitivity of S. pneumoniae to 15 commonly used antimicrobial agents. The resistant phenotype was identified by erythromycin and clindamycin double disk diffusion method. PCR was used to amplify the relevant resist- ant genes. Results Seventy-one strains of S. pneumoniae were included in this study. About 98.6% （70/71） of the strains were susceptible to penicillin. One strain （1.4%, 1/71） was intermediate to penicillin. Most of the strains （84.5%, 60/71 ） were resistant to macrolides. Majority （900/00, 54/60） of these strains were cMLS B phenotype. Five （8. 3%, 5/60） strains showed iMLS B phenotype and 1 （1.7%, 1/60） strain belonged to M phenotype, ermB gene was identified in 59 （98.3%） of the 60 strains of macrolide-resistant S. pneumoniae. Conclusions S. pneumoniae strains associated with community acquired respiratory infections isolated from Chinese adults are highly resistant to macrolides. Macrolides should be used cautiously in community acquired respiratory infections according to the results of susceptibility testing or in combination with β-lactam antibiotics.

关 键 词：大环内酯类 肺炎链球菌 耐药机制 社区获得性肺炎 慢性气管炎急性加重 

分 类 号：R446.5[医药卫生—诊断学]