杭州地区肺炎链球菌耐药性及遗传背景研究.doc

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1、感染性疾病杭州地区肺炎链球菌耐药性及遗传背景研究华春珍尚世强孙晓丰李建平陈志敏俞锡林【摘要】目的了解杭州地区肺炎链球菌儿童株的耐药性和流行特征。方法用KrbrBauer法和Etest法对323株肺炎链球菌致病株和携带株进行咐药性分析，并对青零索耐药株及部分相关菌株用BO疋PCR技术进行遗传背景研究。结果青霉素敏感株136株，占42.1%,青霉素屮介株和耐药株分别占40.2%和17.7%。青霉素的最低抑菌浓度范围为0.012〜4.0Ug/mlo所冇菌株都对头他嚓胯和力古宙索敏感。90.7%的菌株对红禄素耐药，对四环索

2、、甲氮节吩磺胺异噁昨的耐药率也分别高达87.6%和48.6%，对氯霉素的耐药率为14.9%。多重耐药率61.0%，多数对红霉素、四环素和甲氨节I魁硕胺异噁喘联合耐药。99.4%的菌株对利福平和氧緘沙星敏感。BO疋PCR分析耐背宙索肺炎链球菌的临床株，未发现高度集屮分布的BOX图谱，同一-标本中分离到的表型不同的菌株或同一病人多次分离到的菌株BOX图谱可以不完全相同。结论杭州地区肺炎链球菌耐药现彖比较严重，头他噬肪等第三代头他菌素是治疗帅炎链球菌感染的理想药物。同一病人可同时或先后受不同肺炎链球菌克隆感染或定植。【关

3、键词】链球菌，肺炎；儿童；耐药性，微主物；聚合酶链反应AntibioticsresistancepatternandgenetictypeofStreptococcuspneumoniaeisolatedfromchfldreninFhngzhouHUAChiurzhen,SHANGShrqiang,SUNXiairfeng,LIJiairping,CHENZhrmin9YUXrlin.DepartmentqfCentralLaboratory,ChildrensHospitalAffiliatedtoMedica

4、lCollege,ZhejiangUniversity,Hangzhou310003,China[Abstract]ObjectiveToinvestigatetheantibioticyresistancetypeandmolecularepidemiologyofStreptococcuspneumoniaeisolatedfromchildieninHangzhou.MethodsThesensitixdtiesof323strainsofStreptococcuspneumoniaeto9antibioti

5、csweredeterminedinvitiobyKirbyBauerdiffusemethods,andMICsofpenicillinandcefotaximeweredeterminedbyEtestmetliods.ResultsAnx)ngall323strainsisolatedfromchildrenduringtheperiodfromAugust2001toJuly2002,136strains(42.1%)weresensitivetopenicillin、while57strains(17.7

6、%)werepenicillin-resistant.P&iiicillinMICsrangedfrom0.012Ug/mlto4.0Ug/ml.AllthestrainsweresensitivetocefotaximeanditsMICsrangedfiumQ012Ug/mlto4.0Pg/ml・Tliemostresistantantibioticwascrythiomycinandit'sresistant-ratewasashighas90・7%,followedbytetracycline(87.6%)

7、,trimethoprinrsulfamethoxazole(4&6%)andchloiumycetin(!4.9%).Totally197strains(61.0%)weremultrdrug-resistantpncunncocciandnnstofthemwereresistanttoirimcthapiimsulfamethoxazole,crjlhiomycinandtetnicyclineatthesametime・luostrains(0.6%)wereresistanttorifanpinandno

8、newasresistanttovancomycinandofloxacin・BOXPCRtypingwascarriedoutandnooverwhelmingfingerprimingpatternwasfoundarmngpenicillinresistantStreptococcuspneumoniaestrainswhichwereisolated