广州市和大连市淋病奈瑟球菌的耐药性及耐药质粒分型比较

目的 了解广州和大连市两地临床分离的淋病奈瑟球菌(淋球菌)对抗生素的耐药性,以及产β-内酰胺酶淋球菌(PPNG)和四环素高水平耐药淋球菌(TRNG)耐药质粒TEM-1和tetM基因分型差异.方法 临床菌株来自2012年广东省皮肤性病防治中心和大连市皮肤病医院性病门诊患者的泌尿生殖道分泌物.采用琼脂稀释法测定淋球菌菌株对环丙沙星、头孢曲松和大观霉素的耐药性.多重PCR方法鉴定PPNG TEM-1和TRNG tetM基因分型.结果 2012年广州市皮肤性病防治中心和大连市皮肤病医院性病门诊分别分离获得淋球菌127株和102株.大连市淋球菌头孢曲松中介率达到88.2％(90/102),高于广州市的46.5％ (59/127,x2=43.44,P＜0.01),且出现5株大观霉素耐药株(4.9％),而广州市淋球菌对大观霉素100％敏感.广州市PPNG和TRNG流行率分别为46.5％(59/127)和50.4％ (64/127),均明显高于大连市的33.3％(34/102)和24.5％ (25/102),差异均有统计学意义(x2=5.24、15.95,P均＜0.05).广州和大连市TEM-1基因分型以亚洲型为主,分别为84.7％ (50/59)和79.4％(27/34);tetM基因分型以荷兰型占优势,分别为100.0％ (64/64)和92.0％(23/25).结论 广州和大连两地流行淋球菌耐药性存在差异,大连市出现了大观霉素耐药株,且头孢曲松的中介率显著高于广州市.广州市PPNG和TRNG流行率明显高于大连市.两地TEM-1基因质粒分型以亚洲型占优势,tetM基因以荷兰型为主.     

103株淋球菌耐药性研究

目的了解深圳市福田区慢性病防治院2008-2012年103株淋球菌对五种抗菌药的耐药性及产青霉素酶淋球菌PPNG和高水平耐四环素淋球菌TRNG的流行趋势。方法用琼脂稀释法测定头孢曲松、大观霉素、环丙沙星、四环素及阿奇霉素的最低抑菌浓度(MIC),用头孢硝噻吩纸片检测β-内酰胺酶。结果 103株淋球菌检出PPNG35株(34.0%),TRNG62株(60.2%),环丙沙星耐药率达96.1%,高度耐药株(MIC≥16 mg/L)51株(49.5%),阿奇霉素耐药率为16.5%,头孢曲松、大观霉素未发现耐药菌株、抗菌活性均很强。结论持续性监测淋球菌的耐药性变迁是临床减少淋球菌耐药菌珠出现的有效办法。     

200株淋球菌耐药检测结果分析

目的了解本院分离的200株淋球菌对壮观霉素、头孢曲松、头孢克肟、环丙沙星、青霉素和四环素的耐药性,分析耐药菌株的流行特点,指导临床合理用药。方法采用琼脂稀释法测定菌株对6种抗菌素的最小抑菌浓度(MIC),判断敏感性按WHO西太平洋地区淋球菌耐药性监测统一标准。用纸片酸度法监测产β-内酰胺酶淋球菌(PPNG)菌株。结果 200株淋球菌中,对6种抗菌素的耐药率以环丙沙星为首,耐药率高达94.5%;其次是青霉素,耐药率达92.0%,其中产β-内酰胺酶淋球菌(PPNG)49株(24.5%);四环素耐药率为67.5%,其中质粒介导高度耐四环素淋球菌(TRNG)56株,占28.0%;未发现头孢曲松、头孢克肟耐药菌株,但其低敏率分别为7.0%,5.5%,未发现壮观霉素耐药菌株和低敏菌株;环丙沙星、青霉素和四环素MIC50及MIC90均已超过耐药标准;二重耐药青霉素和环丙沙星同时耐药共检出139株(69.5%)最高,青霉素、四环素和环丙沙星同时耐药109株(54.5%)。结论环丙沙星、青霉素和四环素耐药率较高,提示对淋病的治疗效果差;壮观霉素、头孢曲松和头孢克肟的敏感性较高,推荐壮观霉素、头孢曲松和头孢克肟作为本地区治疗淋病的首选药物,同时定期监测淋球菌的耐药性,以指导临床合理应用抗菌素。     

2009——2011年大连市淋球菌耐药趋势分析

目的监测大连市2009——2011年度分离的淋病奈瑟茵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),分析耐药菌株的流行特点。方法用纸片酸度定量法测定β-内酰胺酶,用琼脂稀释法测定大观霉素、环丙沙星、头孢曲松、四环素对淋球菌的最小抑菌浓度(MIc)。结果 320株淋球菌中检测出产青霉素酶淋球菌(PPNG)为44.69%;质粒介导的耐四环素淋球菌(TRNG)为35.62%,呈下降趋势;环丙沙星的耐药率为97.5%,呈上升趋势。未发现对大观霉素和头孢曲松耐药的菌株,头孢曲松中敏呈上升趋势。结论大观霉素可作为治疗淋病的首选药物,环丙沙星已不能作为治疗淋病的临床用药。     

2018-2022年中山地区淋球菌耐药结果分析

目的 了解中山地区淋球菌流行株对常见7种抗生素的耐药趋势,为本地区淋病临床防治提供有效实验室依据。方法 对2018-2022年中山地区东、南、西、北和中部12间医疗机构收集的淋球菌株进行复苏、分纯和鉴定后,采用WHO推荐的琼脂稀释法,对7种抗生素(青霉素、四环素、环丙沙星、头孢曲松、头孢克肟、大观霉素、阿奇霉素)进行最低抑菌浓度(MIC)测定,用纸片酸度法检测其β-内酰胺酶。结果 5年间共监测淋球菌943株,其对青霉素、四环素、环丙沙星、阿奇霉素(2020-2022年)、大观霉素的平均耐药率分别为84.73%、93.85%、99.79%、12.74%;头孢曲松、头孢克肟的平均中敏率分别为8.70%、11.98%,PPNG株(30.57%～64.39%)(χ²=51.985,P<0.01)和TRNG株(30.57%～52.68%)(χ²=30.931,P<0.01)呈显著的上升趋势。结论 青霉素、四环素、环丙沙星均保持稳定的高耐药率,已不适用于临床治疗;头孢菌素(中敏率)、阿奇霉素、大观霉素呈较低耐药率,仍可推荐为本地区治疗淋病的首...     

中国1993～2000年分离淋球菌的流行病学和细菌学特征

目的：研究中国1993-2000年分离的淋球菌对青霉素、四环素、环丙沙星、大观霉素和头孢曲松的敏感性及其营养分型和携带质粒情况，为制订淋病治疗方案和防治对策的参考依据。方法：用琼脂稀释法测定菌株对抗菌药物的敏感性，用改良Catline法和碱裂解法测定菌株的营养分型和携带耐药质粒的情况。结果：8年来共检测了4976株淋球菌对抗生素的敏感性，发现对青霉素耐药率为71.60％，产青霉素酶淋球菌（PPNG）菌株占15.54；对四环素的耐药菌株占93.02％，由质粒介导的高度耐四环素淋球菌（TRNG）菌株占10.48％；环丙沙星的耐药菌株占53.30％；对大观霉素和头孢曲松的耐药菌株分别占0.36％和0.46％。1995年和1996年南京地区菌株的营养分型原型（proto）占46.4％和47.53％，脯氨酸（pro^-）型占48.4％和50.22％。对40株淋球菌作了质粒分型：30株非PPNG菌株中，2株（15％）不含任何质粒；28株含有4.2kb、4.9kb、5.4kb和39.5kb质粒；10株PPNG株和非PPNG株所含有的5.4kb质粒虽分子量相近，但酶切点不尽相同。结论：1993-2000年分离的淋球菌对青霉素、四环素和环丙沙星耐药率较高，对大观霉素和头孢曲松仍较敏感。南京地区1995-1996年流行的淋球菌的营养分型我大变化。含5.4kb质粒的PPNG和非PPNG菌株所含核苷酸的排列顺序可能有所不同。     

广西桂林地区淋病奈瑟菌耐药检测结果分析

目的 分析广西桂林地区淋病奈瑟菌(Neisseria gonorrhoeae, NG)对七种抗生素的耐药性,为临床合理用药提供实验室依据。 方法 采用纸片酸度法检测产青霉素酶淋病奈瑟菌(penicillinase-producing Neisseria gonorrhoeae,PPNG),运用琼脂稀释法测抗生素的最小抑菌浓度(minimum inhibitory concentration, MIC)。 结果 从淋病患者标本中分离菌株361株,其中高度耐四环素淋球菌(tetracycline-resistant Neisseria gonorrhoeae, TRNG)和青霉素耐药并PPNG分别为112株(60.22%)和146株(54.89%)。青霉素敏感0株(0.00%),环丙沙星敏感1株(0.28%),四环素敏感28株(7.76%),阿奇霉素敏感236株(65.37%),未发现大观霉素耐药菌株;头孢曲松和头孢克肟敏感分别为341株(94.46%)和354株(98.06%),其非敏感分别为20株(5.54%)和7株(1.94%)。 结论 大观霉素、头孢曲松和头孢克肟可作为桂林地区治疗淋病的首选药物;持续监测NG耐药性对于指导临床合理用药和发现耐药变化具有十分重要的意义。     

233株淋球菌耐药性的监测与分析

目的了解淋球菌对抗菌药物的耐药性及产青霉素酶淋球菌（PPNG）和高水平耐四环素淋球菌（TRNG）的流行情况。方法用琼脂稀释法测定最低抑菌浓度（MIC）及纸片酸度法测定p内酰胺酶。结果233株淋球菌中检出PPNG阳性32株（13．73％）,TRNG阳性147株（63．09％）。菌株对头孢曲松和大观霉素均敏感,而对环丙沙星、四环素耐药率为98．28％、100％。结论南宁地区淋球菌株的耐药性以环丙沙星、四环素最为严重,对大观霉素和头孢曲松有较高的敏感性,持续开展耐药监测十分必要。     

衡阳地区淋球菌流行株对抗生素耐药性监测

目的了解衡阳地区淋球菌流行株对抗生素的耐药性及产青霉素酶淋球菌(PPNG)和高水平耐四环素淋球菌(TRNG)的流行状况.方法采用琼脂稀释法测定最低抑菌浓度(MIC)以及用改良碘法检测β-内酰胺酶.结果101株淋球菌共检出PPNG 32株(31.7%)、TRNG 20株(19.8%),对四环素、环丙沙星、青霉素及大观霉素的耐药率分别为94.1%、91.1%、89.1%和2.0%,未发现耐头孢曲松钠的菌株.淋球菌交叉耐药情况较为严重,79.2%菌株对青霉素和环丙沙星呈现交叉耐药,84.2%菌株对四环素和环丙沙星呈现交叉耐药.结论头孢曲松钠和大观霉素仍可作为衡阳地区淋病治疗的首选药物,但大观霉素已出现耐药株,应引起临床医师的高度警惕;持续监测淋球菌的耐药性十分重要.     

106株淋病奈瑟菌的耐药性分析

目的了解淋病奈瑟菌(NG)流行株对5种抗生素的敏感性,分析NG的耐药性特点,为淋病的治疗提供依据。方法纸片扩散法检测106株NG对5种抗生素的敏感性,用产色头孢硝噻吩法检测β-内酰胺酶。结果106株NG中检出97株对青霉素耐药(91.5%),由质粒介导的产青霉素酶NG(PPNG)为61株(57.5%),四环素耐药率为70.4%,其中质粒介导高度耐四环素NG(TRNG)为28株,占26.4%,环丙沙星耐药率为92.3%,末发现对大观霉素和头孢曲松的耐药菌株。结论青霉素、四环素以及氟喹诺酮类药物已不宜作为治疗淋病的常规药物,大观霉素、头孢曲松可作为治疗淋病的首选药物。     

Antimicrobial resistance of Neisseria gonorrhoeae in Liberia.

The prevalence and molecular characteristics of penicillinase-producing Neisseria gonorrhoeae (PPNG) and tetracycline-resistant N. gonorrhoeae (TRNG) were determined in 10 clinics in Monrovia, Liberia, to assess the likely effectiveness of the current standard treatment with penicillin or tetracycline. One hundred gonococcal strains were isolated from 146 urethral swabs and 261 cervical swabs and screened for susceptibility to ceftriaxone, penicillin, spectinomycin and tetracycline by the disk diffusion method; 83% were resistant to penicillin and 63% to tetracycline. Twenty-one strains from 18 men and 3 women with uncomplicated gonorrhoea were subjected to more detailed characterization. These 21 strains belonged to 5 auxotype/serovar classes; 86% were PPNG/TRNG. Three PPNG harboured the 4.4 MDa penicillinase plasmid and 16 the 3.2 MDa plasmid. All TRNG harboured the 25.2 MDa plasmid and their MICs for tetracycline were > 32 mg/L. They gave a PCR product which, according to its restriction pattern, corresponded to the American type tetM gene. By the agar dilution method, all strains exhibited intermediate resistance to sulphamethoxazole-trimethoprim (19:1) (co-trimoxazole) with MICs of 8-32 mg/L. All strains were susceptible to spectinomycin and ciprofloxacin. The MICs for gentamicin were 4-8 mg/L. The use of effective and affordable antimicrobial chemotherapy with either 500 mg ciprofloxacin or a single dose of gentamicin is discussed, with consideration of molecular biological, pharmacological and public health aspects.     

Monitoring antimicrobial susceptibility of Neisseria gonorrhoeae isolated from Bangladesh during 1997-2006: emergence and pattern of drug-resistant isolates

Gonorrhoea is one of the most common sexually transmitted infections (STIs) in developing countries, and the emergence of resistance to antimicrobial agents in Neisseria gonorrhoeae is a major obstacle in the control of gonorrhoea. Periodical monitoring of antimicrobial susceptibility of N. gonorrhoeae is essential for the early detection of emergence of drug resistance. In total, 1,767 gonococcal strains isolated from males and females (general population and those with high-risk behaviour) from different parts of Bangladesh were studied during 1997-2006. Minimum inhibitory concentrations of penicillin, tetracycline, ciprofloxacin, ceftriaxone, spectinomycin, and azithromycin for the isolates were determined by the agar dilution method. Isolates resistant to three or more antimicrobial agents are considered multidrug-resistant. The prevalence of plasmid-mediated penicillinase-producing N. gonorrhoeae (PPNG) and plasmid-mediated tetracycline-resistant N. gonorrhoeae (TRNG) was determined. Nine percent of the isolates were resistant to ciprofloxacin in 1997 compared to 87% in 2006. Multidrug-resistant N. gonorrhoeae have emerged in 1997, and 44% of the strains (n = 66) isolated during 2006 were multidrug-resistant. Forty-two percent of the isolates in 2006 were both PPNG- and TRNG-positive compared to none in 1997. The rapidly-changing pattern of gonococcal antimicrobial susceptibility warrants the need for an antimicrobial susceptibility-monitoring programme, and periodical analysis and dissemination of susceptibility data are essential to guide clinicians and for successful STI/HIV intervention programmes.     

Characteristics of gonococci isolated from men with urethritis in Dubai.

Neisseria gonorrhoeae were collected from men attending out-patient clinics in Dubai. The susceptibility to a range of therapeutic antibiotics and their auxotype and serotype was determined. The plasmid content of all penicillinase-producing strains was also analysed. Thirty-six strains of N. gonorrhoeae were isolated from specimens collected from 79 patients over a 24-day period. Of the 36 isolates, 9(25%) were penicillinase-producing N. gonorrhoeae (PPNG) and 15 (42%) were chromosomally resistant N. gonorrhoeae (CMRNG). CMRNG exhibited higher levels of resistance to cefuroxime, chloramphenicol, tetracycline and erythromycin than PPNG. All isolates were susceptible to ceftriaxone and spectinomycin. Three (8%) isolates showed reduced susceptibility (MIC, > or = 0.25 mg/l) to ciprofloxacin. Six isolates of PPNG carried the 4.4 MD and three the 3.2 MD penicillinase encoding plasmid. The total gonococcal population was phenotypically diverse, with 12 serovars, 6 auxotypes and 21 A/S classes. Gonorrhoea was found to be a major cause of urethritis in Dubai and the strains exhibited high levels of resistance to penicillin.     

Antimicrobial susceptibilities and serotyping of Neisseria gonorrhoeae in southern Africa: influence of geographical source of infection.

One hundred and ninety-two strains of Neisseria gonorrhoeae isolated from migrant mine-workers were tested for their susceptibility to antibiotics, auxotyped and serotyped. Of the total, 93 (48%) were acquired locally and 64 (33%) from different geographical locations. Plasmid-mediated resistance to penicillin was found in 28 (14.6%) strains and was associated predominantly with the presence of 5.0 kb penicillinase encoding plasmid (18/28, 64%). Chromosomal resistance to penicillin (MIC > or = 1 mg/l) was detected in 14 (7.3%) strains. Resistance to tetracycline was chromosomally and not plasmid-mediated. Antibiotic resistance was encountered most commonly among strains acquired in Natal. The overall gonococcal population was sensitive to ceftriaxone, ciprofloxacin, spectinomycin and azithromycin. Nine auxotype/serovar (A/S) classes were encountered among penicillinase-producing N. gonorrhoeae (PPNG) compared to 24 A/S classes among non-PPNG strains. The most common A/S class was NR/IA-6 which accounted for 38% of PPNG and 15% of non-PPNG.     

199株淋球菌对环丙沙星和头孢三嗪的敏感性测定

目的 了解南宁地区淋球菌对环丙沙星,头孢三嗪的敏感性。方法 采用琼脂稀释法分别测定环丙沙星、头孢三嗪对199株淋球菌的最小抑菌浓度。结果 环丙沙星MIC范围为0．002－2mg/L,其中1999年MIC范围为0．25－≥16mg/L;14．5％菌株对环丙沙星敏感,41．71％为低度敏感,43．72％为耐药,其中1999年有4株淋球菌MIC≥16mg/L。头孢三嗪MIC为0．02－1mg/L,MIC50为0．03mg/L,MIC90为0．5mg/L;55.28％菌株对头孢三嗪敏感,39.20%为低度敏感,5．53％为耐药。其中,1999年末发现耐药菌株。结论 南宁地区已经不能把环丙沙星作为治疗淋病患者的首选药物;头孢三嗪是否仍能作为治疗淋病的一线药物,尚需进一步研究。     

1 874份前列腺分泌物标本病原学检测与药敏分析

目的了解某地区前列腺炎的病原体种类及其对抗菌药物的敏感性。方法收集前列腺炎患者的前列腺分泌物标本1874份进行病原学检测，并对检出的72株淋病奈瑟菌进行药敏试验（K-B法）。结果共检出452份阳性标本，阳性率为24．12％；其中检出单种病原体的标本334份，检出2种病原体的标本118份，两者所检出病原体以淋病奈瑟菌比率最高，分别占31．14％和55．09％。72株淋病奈瑟菌对环丙沙星、氧氟沙星和青霉素、四环素耐药率较高，分别为90．28％，83．33％，55．56％，25．00％；对壮观霉素100％敏感。结论该地区前列腺炎分泌物病原体检出率高，以淋病奈瑟菌为主。环丙沙星、氧氟沙星、青霉素和四环素已不宜作为该地区治疗淋病奈瑟菌感染的常规药物。     

淋病流行特征与淋球菌药物敏感性的流行病学研究

目的 为控制淋病的增长，探讨淋病流行病特征与淋球菌对常用药物敏感性的流行病学关系。方法 完整收集淋病的流行病学资料，测定每年淋球菌对各种药物的敏感度及耐药率，药物包括青霉素，四环素，环丙沙星，壮观霉素和头孢三嗪。结果 性病流行在10年内稳定上升，但淋病则由1993年开始呈稳定的负增长，壮观霉素及头孢三嗪在4年间未发现耐药菌株；环丙沙星的耐药率显上升，由1998年的56.4%上升至2001年的71.4%，产青霉素的耐药菌株（PPNG）和四环素耐药菌株（TRNG）在4年内分别上升10%和16.3%，结论 随淋病的有效控制，淋球菌对常用药物的敏感性降低，PPNG和TRNG菌株的明显上升表明淋球菌的耐药趋势正逐渐增强，喹诺酮类药物的高耐药率表明该类药物已不再适宜被推荐用于治疗淋病的首选药物，头孢三嗪和壮观霉素尚没有耐药菌株，但必须强调规范使用，保证在性病防治工作中有足够可供选择有效药物。