2种表型试验检测葡萄球菌诱导型克林霉素耐药的评估及基因分析  

Drug resistance evaluation and gene analysis on the detection of inducible clindamycin resistance in Staphylococcus by 2 phenotype tests

作　　者：张静华[1] 袁应华[1] 刘妍[1] 成洁[1] 孙奋勇[1] 

机构地区：[1]同济大学附属第十人民医院,上海200072

出　　处：《检验医学》2015年第12期1238-1242,共5页Laboratory Medicine

摘　　要：目的评价MicroScan革兰阳性复合板(简称PC33复合板)和D试验(红霉素、克林霉素双纸片法)检测葡萄球菌诱导型克林霉素耐药的性能及耐药基因分析。方法检测115株PC33复合板检测结果为红霉素耐药而克林霉素敏感的葡萄球菌对红霉素/克林霉素复合孔的耐药性,同时用D试验检测红霉素对克林霉素的诱导耐药表型,用聚合酶链反应(PCR)检测大环内酯类-林可酰胺类-链阳霉素B类复合药物(MLS)的耐药基因。结果 PC33复合板耐药检出率分别为金黄色葡萄球菌61.3%、凝固酶阴性葡萄球菌47.6%,D试验耐药检出率分别为金黄色葡萄球菌61.3%、凝固酶阴性葡萄球菌51.2%,2种方法的检测结果差异无统计学意义(P>0.5)。以D试验为判断标准计算PC33复合板检测克林霉素诱导耐药的敏感性为95.1%,特异性为100.0%;检出erm基因常见的结构型MLS(cMLS)耐药基因ermA和诱导型MLS(iMLS)耐药基因ermC。结论 PC33复合板与D试验检测葡萄球菌诱导型克林霉素耐药的结果有很好的一致性;PC33复合板有较好的临床应用价值。实验室应加强克林霉素诱导耐药的检测,以指导临床合理选用抗菌药物。Objective To evaluate the drug resistance performance and drug resistance gene on the detection of inducible clindamycin resistance in Staphylococcus by Micro Scan Gram-positive composite plate（ PC33 composite plate）and D test（ erythromycin and clindamycin double-disk diffusion method）. Methods The drug resistance of erythromycin / clindamycin composite well of the 115 isolates which were resistant to erythromycin and sensitive to clindamycin by Micro Scan automatic identification was determined. Meanwhile,the inducible resistant phenotype of erythromycin to clindamycin was analyzed by D test,and the resistant gene to macrolide-lincosamide-streptogramin B（ MLS） was detected by polymerase chain reaction（ PCR）. Results The detection rates of PC33 composite plate were61. 3% for Staphylococcus aureus and 47. 6% for coagulase-negative Staphylococcus. The detection rates of D test were 61. 3% for Staphylococcus aureus and 51. 2% for coagulase-negative Staphylococcus. The difference between the 2 methods had no statistical significance（ P 〉 0. 5）. Using D test as a standard to evaluate PC33 composite plate resistant to inducible clidamycin resistance,the sensitivity was 95. 1%,and the specificity was 100. 0%. The predominant gene for constitutive MLB（ cMLS） resistance to clindamycin was ermA. The predominant gene for inducible MLS（ iMLS）resistance to clindamycin was ermC. Conclusions The detection results of inducible clindamycin resistance in Staphylococcus by MicroScan Gram-positive composite plate show a coincidence with D test. PC33 composite plate has good clinical significance. The detection of inducible clindamycin resistance should be paid attention in laboratories in order to guide physicians to select antimicrobial agents correctly.

关 键 词：诱导型克林霉素耐药 葡萄球菌 MicroScan革兰阳性复合板 D试验 红霉素 基因 

分 类 号：R446.5[医药卫生—诊断学]