广东省5市525株淋球菌临床分离株耐药性的流行病学研究

目的:对2011²012年广东省广州、佛山、江门、肇庆和珠海等五市临床分离的525株淋球菌流行株对青霉素、四环素、环丙沙星、头孢克肟、头孢曲松和大观霉素等6种抗生素的敏感性监测结果进行分析,了解我省不同地区淋球菌耐药株的流行现状。方法:采用琼脂稀释法测定菌株对6种抗菌药物的最小抑菌浓度(MIC),敏感性判断按WHO西太区淋球菌耐药性监测统一标准,其中头孢克肟敏感性试验和判断标准按美国临床和实验室标准化研究所(CLSI)标准判断。用纸片酸度法检测产β-内酰胺酶淋球菌(PPNG)菌株。结果:来自五地525株淋球菌中检出430株对青霉素耐药(81.9%),四环素和环丙沙星耐药株(率)分别为484株(92.2%)和514株(97.9%),未发现对大观霉素、头孢克肟和头孢曲松耐药菌株,但头孢曲松中敏有178株(33.9%),头孢克肟中敏只有7株(1.3%)。青霉素、四环素和环丙沙星的MIC50及MIC90均已超过耐药标准。检出PPNG株189株(36.0%),四环素高度耐药淋球菌(TRNG)248株(47.2%)。2分析显示,肇庆市淋球菌流行株对青霉素的耐药率高于总体水平(2=13.88,P<0.01);广州市四环素耐药率最高(2=10.58,P<0.01);五地市淋球菌对环丙沙星的耐药率较一致(94.1%2012年广东省广州、佛山、江门、肇庆和珠海等五市临床分离的525株淋球菌流行株对青霉素、四环素、环丙沙星、头孢克肟、头孢曲松和大观霉素等6种抗生素的敏感性监测结果进行分析,了解我省不同地区淋球菌耐药株的流行现状。方法:采用琼脂稀释法测定菌株对6种抗菌药物的最小抑菌浓度(MIC),敏感性判断按WHO西太区淋球菌耐药性监测统一标准,其中头孢克肟敏感性试验和判断标准按美国临床和实验室标准化研究所(CLSI)标准判断。用纸片酸度法检测产β-内酰胺酶淋球菌(PPNG)菌株。结果:来自五地525株淋球菌中检出430株对青霉素耐药(81.9%),四环素和环丙沙星耐药株(率)分别为484株(92.2%)和514株(97.9%),未发现对大观霉素、头孢克肟和头孢曲松耐药菌株,但头孢曲松中敏有178株(33.9%),头孢克肟中敏只有7株(1.3%)。青霉素、四环素和环丙沙星的MIC50及MIC90均已超过耐药标准。检出PPNG株189株(36.0%),四环素高度耐药淋球菌(TRNG)248株(47.2%)。2分析显示,肇庆市淋球菌流行株对青霉素的耐药率高于总体水平(2=13.88,P<0.01);广州市四环素耐药率最高(2=10.58,P<0.01);五地市淋球菌对环丙沙星的耐药率较一致(94.1%¹00%);头孢曲松的中敏率之间相差较大(2=19.60,P<0.01),广州收集的淋球菌对头孢曲松的中敏率高于总体中敏率(2=6.96,P<0.01);5地市PPNG流行率有明显差异(2=15.67,P<0.01),其中肇庆PPNG流行率高于总体水平(2=6.31,P<0.05);5地市TRNG流行率无统计学差异(2=4.16,P>0.05)。结论:不同地区的淋球菌流行株对抗菌药物的耐药性有明显差别,广州市收集的淋球菌流行株对头孢曲松中敏率较高,肇庆市收集的淋球菌流行株中PPNG流行率较高。

Antimicrobial Resistance in 525 Clinical Isolates of Neisseria gonorrhoeae from 5 Cities in Guangdong

Objective：To study the current status of antimicrobial resistance to 6 antimicrobial agents of clinical isolates of Neisseria gonorrhoeae from 5 cities in Guangdong province in 2011 - 2012. Methods：The agar dilution method was used to determine the minimum inhibitory concen- trations （MICs） to six antibiotics, i. e., penicillin G, tetracycline, ciprofloxacin, cefixime, ceftriaxone and spectinomycin. The resistance of all strains to six antibiotics was interpreted according to criteria used in the project of surveillance of gonococcal antibiotic susceptibility in the WHO Western Pacific Region and cefixime susceptibilities were interpreted as Clinical and Labora- tory Standards Institute （ CLSI ）. Penicillinase （ β-1actamase ） -producing N. gonorrhoeae （PPNG） was analyzed by the paper acidometric method. Results：525 strains N. gonorrhoeae iso- lates collected from Guangzhou, Foshan, Jiangmen, Zhaoqing and Zhuhai in Guangdong province were studied. 430 isolates （81.9%） showed resistance to Penicillin. The prevalence of tetracy- cline- and ciprofloxacin-resistance was 92.2% and 97.9%, while none of strains appeared to be resistant to spectinomycin, cefixime and ceftriaxone, but 178 （33.9%） and 7 （1.3%） isolates showed reduced sensitivity to ceftriaxone and cefixime, respectively. MIC50 and MIC90 of penicil- lin, tetracycline and ciprofioxacin were significantly higher than resistant standards. 189 （36. 0% ） strains were PPNG and 248 （47.2%） strains were TRNG. Chi-square analysis showed a marked increase in the percentage of N. gonorrhoeae isolates with resistance to Penicillin in Zhaoqing city, and resistance to tetracycline in Guangzhou city. N. gonorrhoeae with reduced susceptibility to ceftraxone was isolated in Guangzhou city, prevalence of PPNG in Zhaoqing city increased com- pared with the average level （P 〈0. 01 ）. There was no significant difference about TRNG preva- lence rate in five cities （ X2 = 4. 16, P 〉 0. 05 ）. Conclusion： There is a significant difference in antimicrobial susceptibility of N. gonorrhoeae from different areas of Guangdong province. A sig- nificant elevation is observed in the percentage of N. gonorrhoeae with reduced susceptibility to ceftriaxone in Guangzhou and the prevalence of PPNG in Zhaoqing city, to which close attention should be paid.