中华皮肤科杂志 ›› 2011, Vol. 44 ›› Issue (7): 472-475.

• 论著 • 上一篇    下一篇

2008年中国淋球菌临床分离株耐药性的流行病学研究

韩燕1,尹跃平2,戴秀芹1,袁柳凤2,向志1,陈祥生3   

  1. 1. 中国医学科学院皮肤病研究所
    2. 南京 中国医学科学院北京协和医学院皮肤病研究所
    3. 医科院皮研所
  • 收稿日期:2010-09-09 修回日期:2011-03-22 出版日期:2011-07-15 发布日期:2011-07-12
  • 通讯作者: 尹跃平 E-mail:yinyp@ncstdlc.org

Antimicrobial resistance in clinical isolates of Neisseria gonorrhoeae in China, 2008: an epidemiological study

1, 1, YUAN LiuFeng1, 1   

  • Received:2010-09-09 Revised:2011-03-22 Online:2011-07-15 Published:2011-07-12

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摘要：

目的 通过对2008年淋球菌耐药监测结果进行分析，了解我国不同地区淋球菌耐药株的流行现状。方法 淋球菌株来自2008年全国淋球菌耐药监测点符合要求的951例淋病患者，其中江苏156例、 浙江71例、福建102例、广东207例，广西77例、海南43例、新疆45例、陕西72例、四川80例、重庆44例、天津54例。通过纸片酸度定量法测定β-内酰胺酶，琼脂稀释法测定大观霉素、环丙沙星、头孢曲松钠、四环素对淋球菌的最小抑菌浓度（MIC）。结果 大观霉素有2株耐药（0.21%），头孢曲松451株中度敏感（47.42%），质粒介导的高度耐四环素淋球菌（TRNG）487株（51.21%），产青霉素酶淋球菌（PPNG）332株（34.91%），环丙沙星928株耐药（97.58%）。淋球菌对多种抗菌药物敏感性间的等级相关分析显示，TRNG阳性率与PPNG阳性率呈正相关（r = 0.20，P < 0.01），淋球菌对头孢曲松的敏感性与PPNG阳性率负相关（r = -0.09，P < 0.01），而淋球菌对头孢曲松的敏感性与对环丙沙星的敏感性及TRNG阳性率、淋球菌对环丙沙星的敏感性与PPNG阳性率及TRNG阳性率间没有相关性。卡方分析显示，各省收集的淋球菌对头孢曲松的中敏率之间相差比较大，广西、海南、新疆、陕西四省的中敏率（分别为87.01%、69.77%、82.22%、86.11%）高于总体水平（47.42%）；陕西省有2株淋球菌对大观霉素耐药；各省收集的淋球菌对环丙沙星的耐药率较一致（86.11% ~ 100%）；广东省收集的淋球菌中TRNG的阳性率（68.60%）明显高于总体水平（51.21%）；四川省、浙江省收集的淋球菌中PPNG的阳性率（分别为63.75%和54.93%）明显高于总体水平（34.91%）（P < 0.05）。结论 不同地区的淋球菌对抗生素的耐药性有明显的差别，其中陕西省收集的淋球菌对首选药物中头孢曲松的中度敏感率及对大观霉素的耐药率较高，应引起重视。

关键词: 流行病学

Abstract:

Objective To study the current status of antimicrobial resistance of clinical Neisseria gonorrhoeae isolates in China by analyzing the surveillance results in 2008. Methods N. gonorrhoeae strains were collected from 951 eligible patients at national monitoring sites for resistance of N. gonorrheae, including 156 patients from Jiangsu province, 71 from Zhejiang province, 102 from Fujian province, 207 from Guangdong province, 77 from Guangxi province, 43 from Hainan province, 80 from Sichuan province, 44 from Chongqing, 45 from Xinjiang Uygur Autonomous Region, 72 from Shaanxi province, and 54 from Tianjin. The production of β-lactamase was detected by paper acidometric testing, and minimum inhibitory concentrations （MICs） were determined by agar dilution method for spectinomycin, ciprofloxacin, ceftriaxone, tetracycline, respectively. Results Among the 951 N. gonorrhoeae isolates, 2 （0.21%） were resistant to spectinomycin, 451 （47.42%）showed reduced sensitivity to ceftriaxone, 928 （97.58%） were resistant to ciprofloxacin. Penicillinase-producing N. gonorrhoeae （PPNG） and plasmid mediated tetracycline-resistant N. gonorrhoeae （TRNG） accounted for 34.91% （332/951） and 51.21% （487/951） of these isolates respectively. Kendall rank correlation analysis showed that there was a positive correlation between the positivity rate of TRNG and PPNG （r = 0.20, P < 0.01）, but a negative correlation between the susceptibility to ceftriaxone in N. gonorrhoeae and positivity rate of PPNG （r = -0.09, P < 0.01）. No correlation was observed between the susceptibility to ceftriaxone and susceptibility to ciprofloxacin or the positivity rate of TRNG, or between the susceptibility to ciprofloxacin and positivity rate of PPNG or TRNG. Chi-square analysis showed a marked increase in the percentage of N. gonorrhoeae isolates with reduced susceptibility to ceftriaxone in Guangxi province, Hainan province, Xinjiang Uygur Autonomous Region and Shaanxi province, the percentage of N. gonorrhoeae isolates with resisitance to spectinomycin in Shaanxi province, prevelance of TRNG in Guangdong province, and prevelance of PPNG in Sichuan and Zhejiang provinces compared with the average level （all P < 0.05）. Conclusions There is a significant difference in antimicrobial susceptibility of N. gonorrhoeae from different areas of China. A significant elevation is observed in the percentage of N. gonorrhoeae with reduced susceptibility to ceftriaxone and resistance to spectinomycin in Shaanxi province, to which close attention should be paid.

Key words: epidemiology