诱导克林霉素耐药的肺炎链球菌临床分离情况调查  

Investigation of inducible clindamycin resistance in clinical isolates of Streptococcus pneumoniae

作　　者：王旭明[1] 周晓君[1] 黄梅会 徐凯[1] 岑健萍 

机构地区：[1]海南省人民医院检验科,海南海口570311 [2]海南医学院检验学系,2017届实习生海南海口570311

出　　处：《中华医院感染学杂志》2017年第24期5534-5536,共3页Chinese Journal of Nosocomiology

基　　金：海南省自然科学基金面上资助项目(817319)

摘　　要：目的调查临床分离的肺炎链球菌对红霉素和克林霉素敏感性及诱导性克林霉素耐药(D-试验阳性)的发生率,以指导临床合理使用抗菌药物。方法选择2016年4月-2017年5月医院住院患者的临床标本中分离的70株肺炎链球菌,肺炎链球菌的鉴定以OP纸片筛查,并采用VITEK-2Compact全自动细菌鉴定仪进行鉴定,D-试验采用美国临床实验室标准化委员会(Clinical and Laboratory standards Institute,CLSI)(2016版)推荐的纸片扩散法,按照其标准进行结果解释。结果 70株肺炎链球菌中红霉素耐药66株占94.3%,克林霉素耐药58株占82.9%;红霉素和克林霉素均耐药58株占82.9%;红霉素耐药而克林霉素敏感8株占11.4%;D-试验阳性占所检测肺炎链球菌的8.6%(6/70),占红霉素耐药而克林霉素敏感肺炎链球菌的75.0%(6/8)。结论分离的肺炎链球菌对红霉素和克林霉素产生了较高耐药率;同时诱导型耐药(iMLS)在临床分离株中较为常见,临床实验室应加强对肺炎链球菌D-试验的检测以指导临床正确使用克林霉素。OBJECTIVE To investigate the sensibility to erythromycin and clindamycin and the incidence of inducible clindamycin resistance in clinical isolates of Streptococcus pneumonia,so as to help clinical physicians to choose appropriate antimicrobial agents.METHODS Seventy examples of S.pneumoniae isolated in Hainan People’s Hospital from Apr.2016 to May 2017 were selected,and screened by OP card and identified by Bio Merieux bacteria analyzer Viket 2 compact.The inducible resistance of S.pneumoniae to clindamycin was checked by D-test according to the standard of Clinical and Laboratory Standards Institute（2016）and the conclusions were interpreted according to the standard.RESULTS Among the 70 strains of S.pneumoniae,66 strains were resistant to erythromycin,accounting for 94.3%,and 58 strains were resistant to clindamycin,accounting for 82.9%.Totally 58（82.9%）strains were resistant to both erythromycin and clindamycin and 8（11.4%）strains were resistant to erythromycin but sensitive to clindamycin.The positive rate of D-testis accounted 8.6%（6/70）among all S.pneumoniae strains and it occupied 75.0%（6/8）among the erythromycin-resistant and clindamycin-sensitive S.pneumoniae strains.CONCLUSION The resistant rates of clinical strains of S.pneumoniae against erythromycin and clindamycin are relatively high in our hospital,and inducible resistance（iMLS）is common in clinical isolates.Clinical laboratories should strengthen the detection of D-test of S.pneumoniae in order to guide the reasonable use of clindamycin in clinical practice.

关 键 词：肺炎链球菌 克林霉素 D-试验 

分 类 号：R378.12[医药卫生—病原生物学]