23株诺卡菌的耐药特点分析  

Analysis of antimicrobial resistance characteristics of 23 Nocardia isolates

作　　者：黄磊[1] 李湘燕[2] 孙立颖[1] 赵婧晨 HUANG Lei;LI Xiang -yan;SUN Li - ying;ZHAO Jing - chen(a Department of Clinical Laboratory;b. Insititute of Clinical Pharmacology, Peking University First Hospital, Beijing 100034, Chin)

机构地区：[1]北京大学第一医院检验科,北京100034 [2]北京大学第一医院临床药理研究所,北京100034

出　　处：《中国临床药理学杂志》2018年第13期1520-1524,共5页The Chinese Journal of Clinical Pharmacology

基　　金：国家自然科学基金资助项目(81201338)

摘　　要：目的分析不同种诺卡菌对常用抗菌药物的耐药特点。方法收集2009年至2017年临床样本中分离的诺卡菌非重复菌株共计23株,用基因测序方法(16S r DNA、sec A1、hsp65和gyr B)准确鉴定到种。用E-test方法测定不同种的诺卡菌对阿米卡星、复方新诺明、庆大霉素、环丙沙星、克林霉素、头孢吡肟、亚胺培南、头孢曲松、阿莫西林/克拉维酸、利奈唑胺、头孢噻肟、红霉素和万古霉素的最低抑菌浓度(MIC)值,根据美国临床和实验室标准协会(CLSI)M24-2A药敏折点判断为敏感、中介和耐药。用Whonet 5.6软件统计不同种诺卡菌对13种抗菌药物的耐药率、MIC50和MIC90。计算多重耐药株在不同种诺卡菌中所占比例。结果 23株诺卡菌中有圣乔治诺卡菌8株、皮疽诺卡菌7株、脓肿诺卡菌4株、巴西诺卡菌2株和豚鼠耳炎诺卡菌2株。不同种诺卡菌耐药谱存在差异,皮疽诺卡菌多重耐药率为71.4%,且对复方新诺明、庆大霉素、克林霉素、头孢吡肟、头孢噻肟的耐药率高,分别为57.1%,85.7%,100.0%,57.1%和57.1%。圣乔治诺卡菌多重耐药率为25.0%,对环丙沙星和万古霉素的耐药率高,均为75.5%,其他种诺卡菌无多重耐药。阿米卡星、亚胺培南和利奈唑胺的总体耐药率低,分别为0,8.7%和0。结论皮疽诺卡菌比其他种诺卡菌的多重耐药情况严重,且对复方新诺明的耐药率较高。阿米卡星、亚胺培南、利奈唑胺的总体耐药率低,可作为诺卡菌初始经验治疗的选择。Objective To summarize the antimicrobial resistance characteristics of different Nocardia species. Methods A total of 23 non-repetitive Nocardia clinical isolates were collected during 2009 and2017. These isolates were identified precisely to species level by DNA sequencing of 16 S r DNA,sec A1,hsp65 and gyr B. E-test method was used to determine the minimum inhibitory concentrations（ MICs） of these Nocardia isolates to amikacin,trimethoprim/sulfamethoxazole（ SXT）,gentamicin,ciprofloxacin,clindamycin,cefepime,imipenem,ceftriaxone,amoxicillin/clavlautic acid（ AMC）,linezolid,ceftaxime,erythromycin and vancomycin. The breakpoints for susceptible,intermediate and resistant were followed by clinical and laboratory standards institute（ CLSI） M24-2 A. Whonet 5. 6 software was used to calculate the resistance rates of the 13 kinds of antibiotics sorted by different Nocardia species,MIC50 and MIC90. The percentage of multidrug resistance（ MDR）was also calculated. Results Among the 23 Nocardia isolates,there were 8 Nocardia cyriacigeorgica, 7 Nocardia farcinica, 4 Nocardiaabscessus,2 Nocardia brasiliensis and 2 Nocardia otitidiscaviarum,respectively. The multidrug resistance rate of Nocardia farcinica was 71. 4%,and the resistance rates of these isolates to SXT,gentamicin,clindamycin,cefepime and ceftaxime were high,which were 57. 1%,85. 7%,100. 0%,57. 1% and 57. 1%,respectively. The multidrug resistance rate of Nocardia cyriacigeorgica was 25. 0%,and the resistance rates of these isolates to ciprofloxacin and vancomycin were high,which were 75. 0% and 75. 0%,respectively. There was no multidrug resistant isolate among other Nocardia species. The resistance rates of amikacin,imipenem and linezolid to all Nocardia species were low,which were 0,8. 7% and 0,respectively. Conclusion Nocardia farcinica was more likely to be MDR and more resistant to SXT compared with other Nocardia species. The resistant rates of amikacin,imipenem and linezolid to all Nocardia species were rather low,thus these antibiotics c

关 键 词：诺卡菌 皮疽诺卡菌 圣乔治诺卡菌 药敏试验 多重耐药 

分 类 号：R978.1[医药卫生—药品]