淋病奈瑟菌临床菌株的耐药性和阿奇霉素耐药机制研究  

Study on drug resistance and azithromycin resistance mechanism of clinical strains of Neisseria gonorrhoeae

作　　者：何菁 杨美娟 俞叶夫 顾旭明 孙爱华 HE Jing;YANG Mei-juan;YU Ye-fu;GU Xu-ming;SUN Ai-hua(Affiliated Hospital of Shaoxing University,Shaoxing,Zhejiang 312000,China;不详)

机构地区：[1]绍兴文理学院附属医院,浙江绍兴312000 [2]杭州医学院基础医学与法医学院,浙江杭州310053 [3]绍兴市越城区府山街道社区卫生服务中心,浙江绍兴312000

出　　处：《中国卫生检验杂志》2022年第6期641-644,共4页Chinese Journal of Health Laboratory Technology

基　　金：国家自然科学基金项目(81772232)。

摘　　要：目的分析绍兴地区淋病奈瑟菌对临床常用抗生素的耐药性,分析阿奇霉素耐药菌株耐药相关基因的突变情况。方法琼脂稀释法检测6种抗生素的最小抑菌浓度(MIC),采用头孢硝噻吩纸片法测定PPNG。PCR扩增淋病奈瑟菌阿奇霉素(AZM)耐药相关基因23S rRNA、rplD、rplV和mtrR(启动区和编码区)并测序。结果PPNG和TRNG的阳性率分别为38.72%和45.79%,未出现头孢曲松和大观霉素耐药株,54株AZM耐药株中呈高度、中度和低度耐药的分别有15株、18株和21株。23S rRNA基因4个等位基因a2143g突变和c2599t突变分别与AZM高度和中低度耐药相关,mtrR基因启动区a缺失与AZM耐药相关但与耐药程度无关,mtrR基因编码蛋白G45D突变与AZM高度耐药相关,而H105Y突变与AZM中度、低度耐药相关。结论头孢曲松和大观霉素可以作为本地区淋病奈瑟菌感染治疗的推荐用药,23Sr RNA4个等位基因、mtrR(启动区和编码区)突变与AZM耐药相关,本地区淋病奈瑟菌阿奇霉素耐药率已达18.18%,应根据药敏结果确定是否用阿奇霉素治疗淋病奈瑟菌感染。Objective To analyze the resistance of N.gonorrhoeae(NG)to commonly used antibiotics and the mutation of azithromycin(AZM)resistant strains.Methods The minimum inhibitory concentration(MIC)of six antibiotics were detected by agar dilution method,and PPNG was determined by cephalothiophene paper acidity method.AZM resistance related genes23S rRNA,rplD,rplV and mtrR were amplified by PCR and sequenced.Results The positive rates of PPNG and TRNG were38.72%and 45.79%,respectively.There were no ceftriaxone and macroamycin resistant strains,and 15,18 and 21 strains showed high,medium and low AZM resistance,respectively.a2143g mutation and c2599t mutation of four alleles of 23S rRNA gene were associated with high and medium and low AZM resistance,respectively.Deletion of promoter a of mtrR gene was associated with AZM resistance but not with AZM resistance degree.Mutation of protein G45D encoded by mtrR gene was associated with high AZM resistance.H105Y mutation was associated with medium and low AZM resistance.Conclusion Four alleles of 23 Sr RNA and mutations of mtrR(priming region and coding region)were associated with AZM resistance.The azithromycin resistance rate of NG in this region reached 18.18%.It is necessary to determine whether azithromycin should be used in the treatment of NG infection according to the results of drug sensitivity.

关 键 词：淋病奈瑟菌 阿奇霉素 耐药 基因突变 

分 类 号：R446[医药卫生—诊断学]