摘要
目的: 探讨某三甲医院甲型流感患儿肺炎链球菌(SPN)耐药分布情况及基因分型研究。 方法: 选取2016年1月至2019年1月在南京市高淳人民医院就诊的476例甲型流感患儿为研究对象,采集患儿咽拭子或鼻拭子标本,采用奥普托欣实验及全自动微生物鉴定仪鉴定出肺炎链球菌后,采用琼脂稀释法通过全自动细菌鉴定/药敏系统进行药敏检测确认,采用聚合酶链式反应检测肺炎链球菌耐药基因分型情况。 结果: 476例甲型流感患儿咽拭子或鼻拭子标本中共分离出肺炎链球菌36株(7.56%),其中对红霉素耐药35株(97.22%),对克林霉素耐药31株(86.11%),对青霉素耐药36株(100.00%),对万古霉素耐药3株(8.33%),对阿奇霉素耐药30株(83.33%),对头孢他啶耐药32株(88.89%),对美罗培南耐药1株(2.78%),对四环素耐药36株(100.00%),对利奈唑胺耐药11株(30.56%),对莫西沙星耐药36株(47.22%);36株肺炎链球菌含pbp2B耐药基因32株(88.89%),含ermA耐药基因17株(47.22%),含mefB耐药基因21株(58.33%),含tetM耐药基因30株(83.33%);pbp2B、ermA、mefB、tetM基因突变与其耐药表型的测定均具有较高一致性,其中对β-内酯酰胺类抗生素青霉素、头孢他啶耐药的肺炎链球菌中pbp2B基因检测出率分别为88.89%、100.00%,对大环内酯类抗生素红霉素、阿奇霉素耐药的肺炎链球菌中ermA、mefB两种基因中的任一种或二者同时存在的耐药基因检出率分别为97.14%、93.33%,对四环素耐药的肺炎链球菌中tetM基因检出率为83.33%。 结论: 肺炎链球菌对青霉素、红霉素、四环素等抗生素的耐药性较高,其耐药性与相关耐药基因(pbp2B、ermA、mefB、tetM)的表达有关,加强病原学检测,便于合理选择抗菌药物。
Objective: To investigate the distribution and genotyping of Streptococcus pneumoniae (SPN) resistance in children with influenza A in a class a hospital of grade III. Methods: 476 children with influenza A treated in Gaochun People's Hospital of Nanjing City were selected from January 2016 to January 2019, samples of pharyngeal swab or nasal swab were collected, after identification of Streptococcus pneumoniae by OPTOXIN test and automatic microbiological identification instrument, the agar dilution method was used to confirm the susceptibility of bacteria by automatic bacterial identification/susceptibility system, and polymerase chain reaction (PCR) was used to detect the drug resistance genotypes of Streptococcus pneumoniae. Results: 36 strains of Streptococcus pneumoniae (7.56%) were isolated from throat swabs or nasal swabs of 476 children with influenza A. Among them, 35 strains (97.22%) were resistant to erythromycin, 31 strains (86.11%) were resistant to clindamycin, 36 strains (100.00%) were resistant to penicillin, 3 strains (8.33%) were resistant to vancomycin, 30 strains (83.33%) were resistant to azithromycin, 32 strains (88.11%) were resistant to ceftazidime. 89%, 1 strain (2.78%) was resistant to meropenem, 36 strains (100.00%) were resistant to tetracycline, 11 strains (30.56%) were resistant to linezolid and 36 strains (47.22%) were resistant to moxifloxacin. 36 strains of Streptococcus pneumoniae contained 32 strains of pbp2B resistance gene (88.89%), 17 strains of ermA resistance gene (47.22%), 21 strains of mefB resistance gene (58.33%) and 30 strains of tetM resistance gene (83.33%). The mutations of pbp2B, ermA, mefB and tetM genes were highly consistent with their drug resistance phenotypes, the detection rates of pbp2B gene in Streptococcus pneumoniae resistant to penicillin and ceftazidime were 88.89% and 100.00% respectively, the detection rates of either or both of ermA and mefB genes exist simultaneously in erythromycin-resistant and azithromycin-resistant Streptococcus pneumoniae were 97.14% and 93.33%, respectively, and the detection rate of tetM gene in tetracycline-resistant Streptococcus pneumoniae was 83.33%. Conclusion: Streptococcus pneumoniae is highly resistant to penicillin, erythromycin, tetracycline and other antibiotics. Its resistance is related to the expression of related resistance genes (pbp2B, ermA, mefB, tetM). Etiological detection should be strengthened to facilitate rational selection of antibiotics.
作者
诸君
孔燕
史箫笛
荣强全
徐飞
ZHU Jun;KONG Yan;SHI Xiaodi(Gaochun People's Hospital of Nanjing City in Jiangsu,Jiangsu Nanjing 211300,China)
出处
《河北医学》
CAS
2020年第1期169-173,共5页
Hebei Medicine
基金
江苏省临床医学科技专项项目,(编号:BL2016143)
关键词
甲型流感
肺炎链球菌
耐药分布
基因分型
Influenza A
Streptococcus pneumoniae
Drug resistance distribution
Genotyping
