2013-2018年浙江省部分地区性病门诊淋病奈瑟菌耐药监测结果分析  

Surveillance results of Neisseria gonorrhoeae resistance in sexually transmitted disease clinics in Zhejiang,2013-2018

作　　者：黄佳[1] 胡丽华[1] 赵建妹[1] 陆明琴[1] 许斌飞 赵林杰 Huang Jia;Hu Lihua;Zhao Jianmei;Lu Mingqin;Xu Binfei;Zhao Linjie(Zhejiang Institute of Dermatology,Deqing 313200,Zhejiang,China;Tongxiang Dermatology Prevention and Treatment Center,Tongxiang 314500,Zhejiang,China;Cixi Dermatology Prevention and Treatment Center,Cixi 315300,Zhejiang,China)

机构地区：[1]浙江省皮肤病防治研究所,浙江德清313200 [2]桐乡市皮肤病防治院,浙江桐乡314500 [3]慈溪市皮肤病防治院,浙江慈溪315300

出　　处：《疾病监测》2020年第5期430-434,共5页Disease Surveillance

基　　金：浙江省医药卫生项目(No.2020PY039);浙江省皮肤病防治研究所科研课题(浙皮办发[2017]23号-3)。

摘　　要：目的分析浙江省部分地区性病门诊淋病奈瑟菌(淋球菌)临床分离株对6种抗生素的耐药变化趋势。方法2013-2018年对浙江省部分地区性病门诊临床分离培养的淋球菌采用琼脂稀释法测定青霉素、四环素、环丙沙星、阿奇霉素、头孢曲松、大观霉素的最小抑菌浓度(MIC);采用纸片酸度法测定质粒介导的产青霉素酶淋球菌(PPNG)菌株。结果6年间共监测672株淋球菌。PPNG和质粒介导的高度耐四环素淋球菌(TRNG)的检出率分别为48.81%(328/672)、45.09%(303/672),各维持在45.71%~52.85%和35.00%~66.32%之间,已处于较高水平,均无明显变化趋势(χ^2=1.372、1.424,P>0.05);环丙沙星耐药率高达100.00%(672/672),未发现敏感株;阿奇霉素耐药率由2013年的12.00%上升到2018年的28.32%,平均24.26%(163/672),变化趋势有统计学意义(χ^2=6.035,P<0.05);头孢曲松的低敏率为9.08%(61/672),大观霉素耐药率为0.60%(4/672),两者的MIC50和MIC90均有一个稀释度的增加,呈显著的变化趋势(χ^2=18.876、8.132,P<0.01)。结论头孢曲松和大观霉素适合作为浙江省部分地区治疗淋病的一线药物,但头孢曲松的低敏率逐年上升,应长期监测其耐药性的动态变化。Objective To analyze the trend of resistance of clinical isolates of Neisseria gonorrhoeae to six antibiotics in some sexually transmitted disease(STD)clinics in Zhejiang province.Methods The minimal inhibitory concentrations(MICs)of penicillin,tetracycline,ciprofloxacin,azithromycin,ceftriaxone and spectinomycin to N.gonorrhoeae were detected by agar dilution method using the isolates from STD clinics in some areas of Zhejiang from 2013 to 2018,and the plasmid mediated penicillinase producing N.gonorrhoeae(PPNG)strain was determined by paper acidity method.Results A total of672 N.gonorrhoeae strains were tested in 6 years.The detection rates of PPNG and plasmid mediated high-level plasmid mediated tetracycline-resistant N.gonorrhoea(TRNG)strains were 48.81%(328/672)and 45.09%(303/672)respectively,the annual detection rate ranged from 45.71% to 52.85% and 35.00% to 66.32% respectively,which were at a high level without significant change(χ^2=1.372,1.424,P>0.05);the resistance rate to ciprofloxacin was as high as 100.00%(672/672),no sensitive strain was found.The resistance rate to azithromycin increased from 12.00%in 2013 to 28.32%in 2018,with the average of 24.26%(163/672),the change trend was significant(χ^2=6.035,P<0.05);the low sensitive rate to ceftriaxone was9.08%(61/672),and the drug resistance rate to spectinomycin was 0.60%(4/672).There was a dilution increase of MIC50 and MIC90 respectively for both antibiotics with a significant change trend(χ^2=18.876,8.132,P<0.01).Conclusion Ceftriaxone and spectinomycin are suitable for the first-line treatment of gonorrhea in some areas of Zhejiang,but the low sensitive rate to ceftriaxone is increasing year by year,and long term surveillance for dynamic change of drug resistance of N.gonorrhoeae in needed.

关 键 词：淋病奈瑟菌 耐药监测 最小抑菌浓度 产青霉素酶淋球菌 大观霉素 

分 类 号：R711.7[医药卫生—妇产科学]