非哺乳期肉芽肿性乳腺炎中亲脂性棒状杆菌的检测及抗菌药物的选择  

Detection of lipophilic corynebacterium and selection of antibacterial drugs in non-lactation granulomatous mastitis

作　　者：杨玮[1] 齐艳[1] 杨慧芬[2] 罗华[2] YANG Wei;QI Yan;YANG Huifen;LUO Hua(Department of Clinical Laboratory,Hangzhou Municipal Hospital of Traditional Chinese Medicine,Hangzhou,Zhejiang 310007,China;Department of Breast Surgery,Hangzhou Municipal Hospital of Traditional Chinese Medicine,Hangzhou,Zhejiang 310007,China)

机构地区：[1]浙江省杭州市中医院检验科,浙江杭州310007 [2]浙江省杭州市中医院乳腺外科,浙江杭州310007

出　　处：《检验医学与临床》2021年第9期1206-1210,共5页Laboratory Medicine and Clinic

基　　金：浙江省基础公益研究项目(LGD20H190002);浙江省卫生和计划生育委员会基金项目(2018PY048)。

摘　　要：目的探讨非哺乳期肉芽肿性乳腺炎患者乳腺穿刺液标本中亲脂性棒状杆菌的分布及对抗菌药物的敏感性。方法选择2017年9月至2018年5月该院收治的20例非哺乳期肉芽肿性乳腺炎患者为研究对象,收集经48 h培养阴性的乳腺穿刺液标本,通过延长培养时间及改变培养条件进行苛养菌的培养。采用16S rRNA测序分析和基质辅助激光解吸离子飞行质谱技术分别进行菌种的鉴定;采用E-test法对最低抑菌浓度(MIC)进行测定,采用欧洲药敏试验委员会(EUCAST)标准进行敏感性判读;采用1%吐温-80血平板进行对照的亲脂性试验。结果共分离得到20株苛养菌,其中16株克氏棒状杆菌,1株结核硬脂酸棒状杆菌,1株棒状杆菌某些种,2株厌氧菌(分别是黑尔嗜胨菌和贪婪丙酸杆菌)。1株结核硬脂酸棒状杆菌对所有试验药物均高度敏感,其余17株棒状杆菌体外对青霉素类、大多数头孢类药物敏感,但对红霉素、克林霉素高度耐药,少部分菌株对左氧氟沙星高度耐药。亲脂性试验显示,所有棒状杆菌均具有良好的亲脂性。结论亲脂性棒状杆菌,尤其是克氏棒状杆菌与非哺乳期肉芽肿性乳腺炎密切相关,亲脂性是其重要的致病因素。实验室须高度重视并改善培养条件及运用基质辅助激光解吸离子飞行质谱技术进行准确鉴定以提高培养检出率。临床治疗建议使用亲脂性较好且敏感的利奈唑胺等抗菌药物进行目标性治疗。Objective To study the distribution of lipophilic corynebacterium in the breast puncture fluid of the patients with non-lactating granulomatous mastitis and its sensitivity to antibacterial drugs.Methods Twenty patients with non-lactating granulomatous mastitis treated in this hospital from September 2017 to May 2018 were selected as the study subjects.The pus samples after 48 h culture negative were collected and conduced the fastidious bacterial culture by extending the culture time and changing the culture condition.The 16S rRNA sequencing analysis and matrix assisted laser desorption ion flight mass spectrometry were used to bacterial identification.The E-test method was used to determine the minimum inhibitory concentration(MIC)and the EUCAST standard was used for conducting the sensitivity interpretation.The control lipophilic experiment was performed by adopting the 1%tween 80 blood plate.Results There were 20 strains of isolated fastidious bacteria,including 16 strains of Corynebacterium kroppenstedtii,1 strain of Corynebacterium tuberculostearicum,1 strain of Corynebacterium sp and 2 strains of anaerobic bacteria(Peptoniphilus harei and Propionibacterium avidum).One strain of bacillus stearate was highly sensitive to all tested drugs,and other 17 strains of corynebacterium were sensitive to penicillin and most cephalosporins,but highly resistant to erythromycin and clindamycin,and a few strains showed high resistance to levofloxacin.The lipophilic experiments showed that all corynebacterium showed good lipophicity.Conclusion Lipophilic corynebacterium,especially Corynebacterium kroppenstedtii is closely related to non-lactation granulomatous mastitis.Lipophicity is an important pathogenic factor.The laboratory must pay great attention to improve the culture conditions and use matrix assisted laser desorption ion flight mass spectrometry for conducting the accurate identification in order to improve the detection rate of culture.Clinical treatment is recommended to use linezolid antibacterial drugs with g

关 键 词：克氏棒状杆菌 非哺乳期肉芽肿性乳腺炎 亲脂性棒状杆菌 

分 类 号：R446.5[医药卫生—诊断学]