72株纹带棒状杆菌对抗菌药物敏感性及其感染或定植患者的临床特征  

Antimicrobial susceptibility of 72 strains of Corynebacterium striatum and the clinical characteristics of the patients infected or colonized with these strains

作　　者：闫小利 陈清清[1] 林玉玲 宋瑞雅 张建明 郑廷金 张志珊[1] YAN Xiaoli;CHEN Qingqing;LIN Yuling;SONG Ruiya;ZHANG Jianming;ZHENG Tingjin;ZHANG Zhishan(Department of Laboratory Medicine,Quanzhou First Hospital Affiliated to Fujian Medical University,Quanzhou Fujian 362000,China)

机构地区：[1]福建医科大学附属泉州第一医院检验科,福建泉州362000

出　　处：《中国感染与化疗杂志》2024年第4期395-401,共7页Chinese Journal of Infection and Chemotherapy

基　　金：泉州市科技局计划项目(2023NS046)。

摘　　要：目的 了解临床分离的纹带棒状杆菌对抗菌药物的敏感性及其感染或定植患者的临床特征。方法 收集福建医科大学附属泉州第一医院2020年7月-2022年9月临床分离纹带棒状杆菌72株,采用肉汤微量稀释法检测细菌对18种抗菌药物的敏感性。PCR扩增检测喹诺酮类耐药决定区相关基因gyrA并进行测序以分析氨基酸突变位点,PCR扩增核糖体甲基化酶基因ermX和氨基糖苷修饰酶基因aphA1并进行测序分析。病史资料分析纹带棒状杆菌感染或定植患者的临床特征。结果 药敏试验结果显示,所有菌株对万古霉素、利奈唑胺和达托霉素均100%敏感,对头孢曲松、环丙沙星及莫西沙星均100%耐药,对青霉素(87.5%)、头孢吡肟(95.8%)、美罗培南(95.8%)、甲氧苄啶-磺胺甲噁唑(90.3%)、红霉素(98.6%)和克林霉素(98.6%)的耐药率较高,对庆大霉素(25.0%)、四环素(30.6%)和利福平(23.6%)耐药率较低。PCR及DNA测序结果显示,3株纹带棒状杆菌发生gyrA基因单点突变(Ser87Val),67株发生双突变(Ser87Phe、Asp91A1a或Ser87Tyr、Asp91Ala),2株发生三位点突变(Ser87Phe、Ala88Pro和Asp91Ala),其中三位点突变是本研究首次发现的突变模式。所有的纹带棒状杆菌均检出ermX基因,aphA1基因检出率为43.1%。病史资料结果显示,72株纹带棒状杆菌主要分离自ICU(占65.2%),标本来源以下呼吸道标本为主(占91.6%),患者平均年龄(68.0±15.3)岁,感染和定植患者比例分别占72.2%(52/72)和27.8%(20/72),两组患者在住院时长≥28 d、合并脑出血、意识障碍及病情恶化方面差异具有统计学意义(P<0.05)。结论 该院临床分离的纹带棒状杆菌均为多重耐药菌,感染患者预后相对较差。Objective To investigate the antimicrobial susceptibility of clinical isolates of Corynebacterium striatum and the clinical characteristics of the patients infected or colonized with these strains.Methods The C.striatum strains isolated from clinical specimens were collected in Quanzhou First Hospital Affiliated to Fujian Medical University from July 2020 to September 2022.The clinical data were analyzed to examine the clinical characteristics of patients with C.striatum colonization or infection.The susceptibility of these strains to 18 antimicrobial agents were tested by broth microdilution method.The gyrA gene related to quinolone resistance determining region was amplified and sequenced to analyze the position of amino acid mutations.The ribosomal methylase gene ermX and aminoglycoside enzyme gene aphA1 were amplified by PCR and sequenced.Results Antimicrobial susceptibility testing indicated that all of the 72 strains were susceptible to vancomycin,linezolid and daptomycin.All stains were resistant to ceftriaxone,ciprofloxacin and moxifloxacin.The C.striatum strains showed high resistance rate to penicillin(87.5%),cefepime(95.8%),meropenem(95.8%),trimethoprim-sulfamethoxazole(90.3%),erythromycin(98.6%)and clindamycin(98.6%),but relatively lower resistance rate to gentamycin(25.0%),tetracycline(30.6%)and rifampicin(23.6%).Sequencing analysis indicated that 3 strains of C.striatum had single mutation of gyrA gene(Ser87Val),67 strains had double mutations(Ser87Phe,Asp91Ala or Ser87Tyr,Asp91Ala)and 2 strains had three point mutations(Ser87Phe,Ala88Pro and Asp91Ala),which was newly identified in this study.The ermX gene was detected in all of the isolates and the prevalence of aphA1 gene was 43.1%.The 72 strains of C.striatum were mainly isolated from ICU(65.2%)and lower respiratory tract specimen(91.6%).The average age of patients was 68.0±15.3 years old.About 72.2%(52/72)of the C.striatum strains were isolated from the patients with infection and 27.8%(20/72)were colonizers.Compared to the patients colonized w

关 键 词：纹带棒状杆菌 GYRA ermX aphA1 

分 类 号：R378[医药卫生—病原生物学]