乐清地区儿童肺炎链球菌耐药性及大环内酯类耐药表型和耐药基因型  

Research of macrolide resistant phenotype and resistant gene and antimicrobial susceptibility in streptococcus pneumonia isolated from children in Yueqing

作　　者：林雪峰[1] 朱旭阳[1] 江丹英 王兵勇[1] 陈静[1] 

机构地区：[1]温州医科大学附属乐清医院检验医学中心,浙江温州325600

出　　处：《全科医学临床与教育》2015年第4期417-419,共3页Clinical Education of General Practice

基　　金：温州市医药卫生科研项目(2014B59)

摘　　要：目的了解乐清地区儿童患者分离的肺炎链球菌耐药性及大环内酯类耐药表型和耐药基因型分布情况。方法对2014年乐清地区儿童患者分离的124株肺炎链球菌采用细菌鉴定分析仪进行9种抗菌药物的最低抑菌浓度(MIC)检测,同时对大环内酯类耐药肺炎链球菌用红霉素和克林霉素双纸片协同试验确定其耐药表型,用聚合酶链反应(PCR)扩增这些菌株的耐药基因ermB和mefE。结果 124株肺炎链球菌中,红霉素、克林霉素、四环素和复方新诺明的耐药率依次为96.77%、93.55%、84.68%和81.45%;青霉素、氯霉素和左旋氧氟沙星的耐药率较低,分别为20.16%、5.65%和0.81%,未发现对阿莫西林/克拉维酸和万古霉素耐药的菌株。120株大环内酯类耐药肺炎链球菌中,大环内酯类耐药表型c MLS占96.67%、i MLS占0.83%、M型占2.50%;耐药基因ermB检出率为97.50%,mefE的检出率为6.67%。结论乐清地区儿童肺炎链球菌对大环内酯类抗生素的耐药性严重,ermB基因介导的c MLS型耐药是大环内酯类耐药的主要原因,大环内酯类抗生素已不是治疗乐清地区儿童肺炎链球菌感染的有效药物。Objective To investigate the distribution of macrolide resistant phenotype and resistant gene, and antimicrobial susceptibility in streptococcus pneumonia isolated from children in Yueqing. Methods A total of 124 streptococcus pneumonia isolates from children in Yueqing was analyzed for detecting minimal inhibitory concentration. Then the macrolide resistance phenotypes were identified by double disc test with erythromycin and clindamycin discs. The ermB and mefE genes were amplified by PCR. Results In 124 strains of streptococcus pneumonia, the resistance rates to erythromycin, clindamycin, tetracycline, and sulfamethoxazole were 96.77%, 93.55%, 84.68% and 81.45% respectively. The resistance rate to penicillin, chloromycetin and levofloxacin were lower which were 20.16%, 5.65% and 0.81%respectively.No strain was found that resistant to amoxicillin and vancomycin. Majority（96.67%） of 120 streptococcus pneumonia strains of macrolide were c MLS phenotype. One（0.83%） strain showed i MLS phenotype and 3（2.5%） strains belonged to macrolide resistance phenotype. The ermB gene was identified in 97.50% and mefE gene was 6.67%. Conclusion The resistance of streptococcus pneumonia to macrolide is serious in children from Yueqing. The ermB-mediated c MLS is the most prevalent phenotype among macrolide resistance streptococcus pneumonia isolates. Obviously, the macrolide antibiotic is not effective on streptococcus pneumonia infection.

关 键 词：肺炎链球菌 大环内酯类 耐药基因 ERMB基因 mefE基因 

分 类 号：R440[医药卫生—诊断学]