住院婴儿呼吸道脲原体生物群和耐药性分析  

An analysis on biovars and antimicrobial susceptibility of 78 Ureaplasma strains isolated from respiratory tract of hospitalized infants

作　　者：蒋蓉[1] 陈学军[2] 周明明[2] 方潮[2] 吕建新[1] 

机构地区：[1]温州医科大学检验医学与生命科学学院,浙江温州325035 [2]浙江大学医学院附属儿童医院

出　　处：《预防医学》2017年第3期231-235,共5页CHINA PREVENTIVE MEDICINE JOURNAL

摘　　要：目的观察住院婴儿呼吸道脲原体的生物群构成和耐药情况,为预防和治疗婴儿脲原体感染提供依据。方法于2012年11月—2015年12月1日采集某综合性三甲儿童医院住院婴儿鼻咽部咽拭子(痰液)标本,采用Mycoplasma IST-2(bio Merieux)试剂盒对标本进行培养鉴定及药敏试验,采用PCR方法进行脲原体生物分群、红霉素甲基化酶(ermA、ermB、ermC)和主动外排泵(mef A/E、msr A/B、mre A)可转移耐药基因检测。比较不同生物群脲原体对9种常见抗生素耐药率和红霉素耐药基因检出率差异。结果 78株脲原体培养阳性,其中48株(61.54%)脲原体分离自早产儿。生物1群51株,占65.38%;生物2群27株,占34.62%。不同生物群在患儿性别、是否早产儿、年龄、出生胎龄、出生体重及住院天数等方面差异均无统计学意义(P>0.05)。78株脲原体对环丙沙星和氧氟沙星的耐药率较高,均为80.77%;对四环素的耐药率为1.28%;对多西环素、交沙霉素和原始霉素高度敏感;对大环内酯类抗生素(红霉素、阿奇霉素和克拉霉素)耐药率较低,均<12%。不同生物群对这9种抗生素的耐药率差异均无统计学意义(P>0.05)。仅有甲基化酶耐药基因(ermB)、主动外排泵可转移耐药基因(msr A/B)阳性扩增,检出率分别为39.74%和12.82%。ermB主要存在于生物2群,检出率为55.56%(P<0.05),msr A/B在脲原体两大生物群中分布较均衡(P>0.05)。78株脲原体分别来自新生儿败血症24例,先天感染性肺炎30例,早产儿视网膜病9例,新生儿颅内出血9例,支气管肺发育不良15例。这些疾病在生物1群和2群的分布差异均无统计学意义(P>0.05)。结论婴儿呼吸道分离的脲原体以生物1群为主,在早产儿中检出率更高;对大环内酯类抗生素耐药率较低,可作为治疗婴儿脲原体感染的首选药物;红霉素耐药基因ermB主要分布在生物2群。Objective To learn the biovars, antimicrobial susceptibility in Ureaplasma species isolated from respiratory tracts of infants hospitalized in tertiary children s hospital, and to provide evidences and clinical basis for the prevention and treatment of Ureaplasma infection in infants. Methods Ureaplasma species cultivation, identification and antibiotic susceptibility testing were performed using Mycoplasma IST2. The primers according to the conservative MB - Ag gene were designed to identify Ureaplasma biovars. Erythromcin resistant genes （ ermA, ermB and ermC） and active efflux transporter genes （mefA/E, msrA/B and mreA）were amplified using PCRs. Results A total of 78 Ureaplasma positive cases, of them, 48 Ureaplasma strains were isolated from premature neonates. Biovar 1 was present in 51 （65. 38% ） strains, and biovar 2 was present in 27 （ 34. 62% ） strains. There were no significant differences among sex, premature infant , age, gestational age , birth weight , length of stay （ P 〉 0. 05 ） . The drug resistance rates to ciprofloxacin and ofloxacin were 80. 77%,and to tetracycline was 1. 28%. All strains were sensitive to doxycycline, josamycin and pristinomycin. The drug resistance rates to the macrolide antibiotics （erythromycin, azithromycinand and clarithromycin） were 〈 12% . There was no statistically significant difference among the drug resistance rates of different biovars and these antibiotics （ P 〉 0.05）. Only the methylated enzyme gene （ ermB） and the active efflux pump gene （msrA/B） were detected, and the detection rate was 39. 74% and 12. 82% respectively. The ermB gene mainly exists in biovar 2, and the detection rate is 55.56% （P 〈0.05）. The msrA/B was balanced distributed between biovar 1 and 2 （ P 〉 0.05）. A total of 78 Ureaplasma strains were isolated from 24 cases of neonatal septicemia, 30 cases of congenital infection pneumonia, 9 cases of retinopathy of prematurity, 9 cases of neonatal intracranial hem

关 键 词：解脲脲原体 微小脲原体 药敏 ERMB基因 msrA/B基因 

分 类 号：R446.5[医药卫生—诊断学] R722[医药卫生—临床医学]