淋球菌抗生素耐药谱和质粒图谱研究

目的 为了解广州地区淋球菌的性素耐药谱和质粒谱。方法 采用琼脂稀释法测定了５种抗生素对８９株淋球菌的最小抑菌浓度（ＭＩＣ）和碱裂解法分析１０６株菌的质粒衅谱。结果 ２株为产β－内酰胺酶菌株（ＰＰＮＧ）,３株为质粒介导的高度耐四环素菌株９ＴＲＮＧ０;环丙沙星耐药率较高（６２．９％）,青霉素次之（５９．５％）,头孢三嗪和壮观霉素未发现耐药菌株。质粒检出率为９０．６％,其中２．６Ｍｄ隐蔽质粒携带率为８５．６％,４．５ＭｄＲ质粒为６７．８％,２４．５Ｍｄ结合质粒为３３．８％。质粒谱型以２．６Ｍｄ＋４．５Ｍｄ和２．６Ｍｄ＋４．５＋ｉ２４．５Ｍｄ多见,分别为３７．７％和２５．４％。结论 表明了广州地区淋球菌抗生素耐药谱和质粒图谱,有助于淋病的治疗和防治。     

淋球菌对5种抗生素的敏感性测定

对２０６株淋球菌进行青霉素、四环素、头孢三嗪、壮观霉素、环丙沙星的最小抑菌和浓度和β－内酰胺酶测定。结果显示９株为产青霉素酶淋球菌。染色体介导的耐青霉素和耐四环素的菌株分别为９７株（４７．０９％）和１０２株（４９．５１％）。全部分离菌株对头孢三嗪和壮观霉素敏感。３４株（１６．５％）对环丙沙星耐药。该研究为临床医生合理使用抗生素治疗淋病提供实验依据。     

单剂量口服头孢布烯治疗无合并症淋病的疗效观察

头孢布烯（ｃｅｆｒｉｂｕｔｅｎ）是第三代口服头孢类抗生素。我们于１９９８年２月～７月用其治疗无合并症淋病，并与头孢曲松比较，取得了满意的疗效，现报告如下。１资料和方法１．１病例选择：选择临床和实验室检查确诊，并符合验证要求的无合并症淋病患者。１．２治疗方法、剂量及疗程：（１）试验组：头孢布烯（商品名先力腾，美国先灵葆雅公司生产，批号ＣＮ７３７５）４００ｍｇ单剂量口服。（２）对照组：头孢曲松（商品名罗氏芬，上海罗氏制药有限公司生产，批号为Ｂ２３８）２５０ｍｇ单剂量肌注。１．３疗效观察方法：（１）试…     

广州地区淋球菌对抗生素耐药性测定结果

用琼脂稀释法测定青霉素、头孢三嗪、壮观霉素、环丙沙星、四环素５种抗生素对１２４株淋球菌的最低抑菌浓度（ＭＩＣ），以及用纸片磺量法检测β－内酰胺酶了。结果显示：１２４株淋球菌检出β－内酰胺酶菌株（ＰＰＮＧ）４株（３．２２％）、耐四环素菌株（ＴＲＮＧ）阳性２株（２．６２％）、环丙沙星高度耐药株ＭＩＣ大于８ｍｇ／Ｌ１９株（１５．３％），未发现对头孢三嗪、壮观霉素耐药菌株，但头孢三嗪敏感性呈下降趋势，应引     

淋球菌对五种抗菌药物的敏感性测定及营养型分布

为了解淋球菌分离株耐药的比率及特性，以评价现行淋病治疗方案的有效性及药物敏感性与营养型之间的关系，我们对１９９４年７月至１９９５年６月由四个城市性病门诊患者分离的３９０株淋球菌作了抗菌药物敏感性及营养型测定。以琼脂稀释法测定了５种监测抗菌药物的最小抑菌浓度（ＭＩＣ）。５株为产青霉素酶淋球菌（ＰＰＮＧ）。染色体介导的耐青霉素及耐四环素的菌株（ＭＩＣ≥１ｍｇ／Ｌ）分别为３１４株（８０．５１％）及３７２株（９５．３８％）。４４株（１１．２８％）对环丙沙星耐药（ＭＩＣ≥１ｍｇ／Ｌ）。３８９株（９９．７４％）对壮观霉素敏感（ＭＩＣ≤３２ｍｇ／Ｌ）。全部分离株对头孢三嗪敏感。４０株（１０．２６％）为多重耐药菌株，同时对青霉素、四环素及环丙沙星耐药。３９０株淋球菌中存在８种营养型，以需脯氨酸及原型菌株占优势。需脯氨酸的菌株对环丙沙星的敏感性低于原型菌株。本研究表明，耐青霉素及四环素的菌株比率较高，出现对环丙沙星耐药的菌株。持续性监测淋球菌对抗菌药物的敏感性十分重要。     

淋球菌对头孢三嗪的敏感性测定

目的：了解淋球菌对头孢三嗪的敏感性。方法：我们对１９８９年～１９９６年间由１０个城市淋病患者中分离出的１３２９株淋球菌临床分离株进行了头孢三嗪敏感性测定。以琼脂稀释法测定头孢三嗪的最小抑菌浓度（ＭＩＣ）。结果：头孢三嗪ＭＩＣ范围为０．００２～２ｍｇ／Ｌ。ＭＩＣ５０为０．０３ｍｇ／Ｌ，ＭＩＣ９０为０．１２５ｍｇ／Ｌ。６１．４７％的菌株对头孢三嗪敏感（ＭＩＣ≤０．０３ｍｇ／Ｌ），３７．４７％为低敏ＭＩＣ，ＭＩＣ达１ｍｇ／Ｌ的耐药菌株占１．０５％。自１９９５年起未分离出耐药菌株。结论：研究表明我国目前流行的淋球菌菌株基本上对头孢三嗪敏感。     

淋球菌对环丙氟哌酸的药物敏感度测定

为了解我国淋球菌对氟喹诺酮类药物的敏感性，以琼脂稀释法测定了１９９４年７月～１９９６年７月由４个城市分离的５３５株淋球菌对环丙氟哌酸的敏感性，环丙氟哌酸最小抑菌浓度的范围为０．００２～〉２ｍｇ／Ｌ，７３株（１３．６４％）对环丙氟哌酸耐药，４９株（９．１６％），对环丙氟哌酸敏感。４１３株（７７．１９％）为低敏，４个城市对氟喹诺酮耐药的淋球菌的比率介于７．４６％～２５．５５％，耐药菌株比率呈上升趋势，     

649例淋球菌的血清学分型

目的 研究德国海德堡地区１９８５年－１９９０年间淋球菌血清学分型的变化,方法 协同凝集试验,结果 ６４９株淋球菌标本血清学分型检测显示,在已知的２４种特异性蛋白Ａ（ＰＩＡ）和３１种特异性蛋白Ｂ（ＰＩＢ）中分别检出８种和２６种血清型,其中最常见的６种血清型分别为ＩＢ－３（１９．０％）,ＩＢ－４（１６．０％ＩＢ－２（１５．７％）ＩＢ－１（１３．１％ＩＡ－１／２（１１．７％）和ＩＡ－６（３．２％）此外,     

交沙霉素治疗淋病、非淋菌性尿道炎疗效观察

交沙霉素治疗淋病、非淋菌性尿道炎疗效观察郧阳医学院附属太和医院皮肤科瞿锐治疗方法：口服国产交沙霉素０．２，每日４次，连服１０日。停药５日后观察疗效。结果：淋病组痊愈率６６．７％（８／１２），非淋菌性尿道炎组痊愈率５７．１％（８／１４），混合感染组痊愈...     

淋球菌对头孢菌素类药物敏感性的检测

目的评估药敏纸片琼脂扩散法（K-B法）检测淋球菌对三代口服头孢菌素类药物敏感性的符合率。方法中国医学科学院皮肤病研究所性病科门诊收集的100株淋球菌临床分离菌株。采用K-B法检测淋球菌对头孢克肟、头孢泊肟、头孢布坦3种药物的敏感性;Etest法检测淋球菌对头孢克肟、头孢泊肟的敏感性;最低抑菌浓度琼脂稀释法（MIC法）检测淋球菌对头孢布坦的敏感性。结果K-B法和Etest法对头孢克肟敏感菌株的检测率分别为92．0％和100％;K-B法和Etest法对头孢泊肟敏感菌株的检测率分别为94．9％和100％;K-B法和MIC法对头孢布坦敏感菌株的检测率分别为93．0％和95．3％。结论K-B法对3种药物敏感菌株的检测率与Etest或MIC法检测结果差异无统计学意义。     

Gonorrhea

This review presents the epidemiologic, diagnostic, and office management of the gonorrhea patient. Better techniques in obtaining specimens from various sites are reviewed. For example, an effective method for obtaining specimens without the use of an anoscope and the utility of the Gram stain in the laboratory diagnosis of gonorrhea are described. Complications, diagnosis and predisposing factors of disseminated gonococcal infections are also discussed. Follow-up management of patients with gonorrhea with emphasis placed on test-of-cure cultures and testing for penicillinase producing Neisseria gonorrhoeae (PPNG) strains in all treatment failure cases is also presented. The cooperation between public and private health professionals and screening programs have lessened the gonorrhea reservoir in the United States. Therefore, early treatment through targeted screening, and epidemiologic treatment to sexual partners are important guidelines in gonorrhea control.     

广东省汕头市92株淋球菌药物敏感性检测

目的：了解汕头地区2009年淋球菌对多种抗菌药物耐药的发生率及产β-内酰胺酶淋球菌（PPNG）和四环素高度耐药淋球菌（TRNG）的流行状况.方法：采用琼脂稀释法测定5种抗菌药物最低抑菌浓度（MIC）,纸片酸度法测定青霉素产β-内酰胺酶菌株.结果：92株淋球菌对青霉素耐药率为84.8%、四环素耐药率为89.1%、环丙沙星耐药率为92.4%;未发现大观霉素及头孢曲松耐药菌株.检出PPNG高达31株（33.7%）.TRNG为47株（51.1%）.青霉素﹑四环素和环丙沙星的MIC50及MIC90均已超过耐药标准.结论：大观霉素和头孢曲松为汕头地区治疗淋病的首选药物.     

淋球菌青霉素结合蛋白PPNG基因与耐青霉素类药物的关系

目的　探讨淋球菌青霉素结合蛋白 2基因 (PenA)突变及产青霉素酶淋球菌 (PPNG)与耐青霉素类药物的关系。方法　采用巢式聚合酶链技术对 97株淋球菌临床分离株进行PPNG基因检测 ,并对 4例PPNG基因检测阴性、而抗生素药敏试验表明对青霉素类药物耐药的淋球菌菌株的PenA基因进行测序。结果　 97株淋球菌菌株中有 67株为PPNG基因检测阳性 ;而 4株PPNG阴性的耐药菌株的PenA基因序列均存在点突变。结论　PPNG所导致的耐药是淋球菌耐青霉素类药物的主要来源 ;PenA基因突变是产生耐药菌株的主要原因。     

1988-2002年上海分离的淋球菌对抗菌药的敏感性监测

目的 了解上海地区1988-2002年淋球菌对多种抗菌药耐药的发生率、流行情况和耐药特征.方法 采用琼脂稀释法测定抗菌药耐药性,纸片酸度定量法测定青霉素产β-内酰胺酶菌株(PPNG).结果 青霉素敏感性从1988年的11.28%降至2002年的0,MIC50和MIC90分别增加了8倍和4倍,2002年的耐药率达到94.29%,PPNG株达到了50.95%;高度耐四环素株(TRNG)从1995年的0上升到2002年的20.95%;头孢曲松敏感株已由1995年的100%下降至2002年的23.80%;大观霉素的敏感性维持在高点(>97%);环丙沙星敏感性有较大幅度下降,其耐药率在2002年达到了99.05%.分析多重耐药株,同为耐青霉素、环丙沙星和四环素3种药物的菌株从2001年的20.87%上升到2002年的23.30%.同为耐青霉素和环丙沙星2种药物的菌株近2年都已接近70%.结论 近15年来,淋球菌对多种药物产生了耐药,耐药率逐年提高.建议上海地区将大观霉素和头孢曲松作为治疗淋病的首选药物,并且尽早研制出对淋球菌敏感的抗菌药.     

Gonorrhea prevalence and coinfection with chlamydia in women in the United States, 2000

BACKGROUND: No recent national data address the prevalence of gonorrhea. GOAL: The goal was to describe gonorrhea prevalence and chlamydial coinfection among women aged 15 to 24 years. STUDY DESIGN: Data were analyzed from tests for chlamydia and gonorrhea at family planning, STD, and prenatal clinics in 2000. Gonorrhea positivity, chlamydia positivity among women with gonorrhea, and the median and interquartile ranges (IQRs) were calculated. RESULTS: The median state-specific gonorrhea positivity among women aged 15 to 24 years was 0.9% (IQR, 0.7%-1.7%) in family planning clinics, 7.0% (IQR, 4.1%-10.4%) in STD clinics, and 1.0% (IQR, 0.8%-1.6%) in prenatal clinics. Gonorrhea positivity was higher among females aged 15 to 19 years than among those aged 20 to 24 years. Median chlamydia positivity for females infected with gonorrhea was highest among those aged 15 to 19 years (46%). CONCLUSIONS: Gonorrhea positivity was consistently highest among women aged 15 to 19 years; almost half of women aged 15 to 19 years with gonorrhea also had chlamydia.     

淋球菌对头孢菌素耐药的治疗应对措施

淋病是淋球菌感染引起的性传播疾病之一,对人类健康及社会经济发展均有较大的危害.近年来,由于治疗不当、患者有耐药基因等多种原因,淋球菌逐渐对青霉素、四环素、环丙沙星等抗菌药出现耐药.目前头孢菌素为治疗淋球菌感染的一线药物,随着头孢菌素的广泛应用,淋球菌对其敏感性逐渐降低,出现临床治疗淋病失败的病例.为了进一步控制淋病,应对淋球菌耐药现象,临床已出现联合治疗、替代疗法、新药研发等方案,以期为控制对头孢菌素耐药的淋病治疗提供应对策略.     

西安地区2002-2009年淋球菌耐药性趋势分析

目的 监测西安地区淋球菌对抗生素的耐药性及产青霉素酶(PPNG)和质粒介导的耐四环素菌株(TRNG),了解淋球菌耐药趋势.方法 2002-2009年从性病门诊确诊的淋病患者中分离647株淋球菌.采用琼脂稀释法检测菌株是否为TRNG及对抗生素最低抑菌浓度(MIC),采用纸片酸度法测定菌株是否产β-内酰胺酶(PPNG).结果 647株淋球菌中,检出216株(33.4%)TRNG,PPNG为290株(44.8%).TRNG的阳性率保持在28.3%～49.2%,只有2005年阳性率是17.3%.PPNG阳性率由2002年的37.1%上升到2005年的64%,呈递增趋势,但2006-2009年又逐年下降,2009年下降到32.3%.大观霉素的耐药率为0～2.8%.环丙沙星的耐药率除2006年(51%)有所下降以外,其余均在80%以上,2005年达到100%.头孢曲松的耐药率除2003年发现4株耐药外,其余无耐药株出现,但敏感菌株逐渐减少,中敏菌株逐年递增.结论 淋球菌对大观霉素敏感性高,应做为治疗淋病的首选药物,头孢曲松治疗淋病应注意给足剂量,环丙沙星不能做为治疗淋病用药.

Abstract：

Objective To monitor the antibiotic resistance in Neisseria gonorrhoeae, determine the prevalence of penicillinase-producing Neisseria gonorrhoeae (PPNG) and plasmid-mediated tetracycline-resistant Neisseria gonorrhoeae (TRNG) in Xi'an region, and to analyse the trends in antibiotic resistance in Neisseria gonorrhoeae. Methods In total, 647 strains of Neisseria gonorrhoeae were isolated from patients with gonorrhea in sexually transmitted disease (STD) clinic settings from 2002 to 2009. Agar dilution method was used to detect TRNG and determine the minimal inhibitory concentration (MIC) of antibiotics, and paper acidometric method to detect PPNG. Results Of these 647 strains, 216 (33.4%) were TRNG, 290 (44.8%)were PPNG. The prevalence of TRNG strains remained between 28.3% and 49.2% in 2002-2009, except for 17.3% in 2005; the prevalence of PPNG strains increased from 37.1% in 2002 to 64% in 2005, but declined from 2006 to 2009 (32.3%). The prevalence of resistance to spectinomycin maintained at a low level (0 to 2.8%) over these years, while that to ciprofloxacin remained higher than 80% from 2002 to 2009, and accounted for 100% in 2005, with the exception of 51% in 2006. Ceftriaxone resistance was observed in none of these strains except 4 isolates in 2003, but the susceptibility to ceftriaxone decreased yearly. Conclusions Neisseria gonorrhoeae is highly sensitive to spectinomycin, which should serve as the first treatment choice for gonorrhea.Full dose is necessary for the application of ceftriaxone in the treatment of gonorrhea. Ciprofloxacin should not be used to treat gonorrhea.     

Pharyngeal carriage of Neisseria meningitidis and anogenital gonorrhea: evidence for their relationship

The relationship between pharyngeal carriage of Neisseria meningitidis and anogenital infection with Neisseria gonorrhoeae was investigated at two separate clinics for sexually transmitted diseases in New York City. Of the entire study group of 738 patients, 310 (42%) had pharyngeal N. meningitidis. Gonorrhea appeared in 130 (17.9%) of the 738 patients. Of the 130 patients with anogenital gonorrhea, 73 (56.3%) had N. meningitidis-positive pharyngeal cultures. Neisseria meningitidis was found in the pharyngeal cultures of 39% of the gonorrhea-free patients; 23.2% of patients with N. meningitidis-positive pharyngeal cultures had concomitant anogenital gonorrhea. Of the patients free of pharyngeal N. meningitidis, 13.1% had anogenital gonorrhea. In both facilities, the pharyngeal carriers of N. meningitidis had a 1.9 times greater risk of genital gonorrhea as compared with N. meningitidis-negative patients. Patients with anogenital gonorrhea at both study sites were 1.4-1.7 times more likely to be pharyngeal carriers of N. meningitidis as compared with gonorrhea-free patients.     

单纯性淋病400例不同治疗方案疗效比较

目的了解开封地区淋球菌的敏感药物,探讨该地区淋病治疗方案。方法选取400例淋病患者,测定淋球菌菌株对抗生素的敏感性,并按拟定方案(大剂量及联合应用抗菌药物)和卫生部2000年推荐方案用不同药物对400例淋病患者进行分组治疗,对治疗结果进行统计学分析。结果大剂量及联合应用抗菌药物治疗方案治愈率高于卫生部2000年推荐方案(试验组治愈率99.5%,对照组为92.0%;P<0.005)。结论本地区治疗单纯性淋病宜选用①大剂量头孢三嗪;②头孢三嗪+氧氟沙星;③氧氟沙星+大观霉素。