淋病奈瑟菌对阿奇霉素的耐药性及其研究进展

doi:10.3760/cma.j.issn.0412-4030.2018.05.022

摘要/Abstract

摘要： 为提高治疗效果和延缓淋球菌对广谱头孢菌素（extended?spectrum cephalosporins，ESC）耐药性的发展速度，美国、澳大利亚、加拿大和欧洲等国家或地区均推荐采用头孢曲松0.25或0.5 g单次肌内注射联合阿奇霉素（azithromycin， AZM）1或2 g单次口服作为无并发症淋病的一线治疗方案［1?3］。而且ESC联合AZM治疗可能对咽部淋球菌感染具有更好的疗效［4］。然而，AZM耐药淋球菌的流行，特别是AZM高度耐药菌株在多个国家或地区出现，对联合治疗方案的长期有效性造成了威胁。在缺乏新的治疗淋病有效药物前提下，有必要增加对AZM耐药淋球菌的耐药现状、耐药机制及产生原因的了解，以更有效地筛查或监控AZM耐药菌株，控制或延缓其耐药性的蔓延……

关键词: 淋病奈瑟菌, 阿奇霉素, 耐药性

Key words: Neisseria gonorrhoeae, azithromycin, antimicrobial resistance

中图分类号:

R759

万川苏晓红. 淋病奈瑟菌对阿奇霉素的耐药性及其研究进展[J]. 中华皮肤科杂志, 2018, 51(5): 394-396.

chuan Xiaohong Su. Resistance of Neisseria gonorrhoeae to azithromycin: an update[J]. Chinese Journal of Dermatology, 2018, 51(5): 394-396.

参考文献 25

［1］	Workowski KA, Bolan GA, Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015［J］. MMWR Recomm Rep, 2015, 64（RR⁃03）: 1⁃137. doi: 10.18370/2309⁃4117.2015.24.51⁃56.<br />
［2］	Bignell C, Unemo M. 2012 European guideline on the diagnosis and treatment of gonorrhoea in adults［J］. Int J STD AIDS, 2013,24（2）:85⁃92. doi: 10.1177/0956462412472837.<br />
［3］	Unemo M. Current and future antimicrobial treatment of gonorrhoea ⁃ the rapidly evolving Neisseria gonorrhoeae continues to challenge［J］. BMC Infect Dis, 2015,15:364. doi: 10.1186/s12879⁃015⁃1029⁃2.<br />
［4］	Barbee LA, Kerani RP, Dombrowski JC, et al. A retrospective comparative study of 2⁃drug oral and intramuscular cephalosporin treatment regimens for pharyngeal gonorrhea［J］. Clin Infect Dis, 2013,56（11）:1539⁃1545. doi: 10.1093/cid/cit084.<br />
［5］	Belkacem A, Jacquier H, Goubard A, et al. Molecular epidemiology and mechanisms of resistance of azithromycin⁃resistant Neisseria gonorrhoeae isolated in France during 2013⁃14［J］. J Antimicrob Chemother, 2016,71（9）:2471⁃2478. doi: 10.1093/jac/dkw182.<br />
［6］	Galarza PG, Alcalá B, Salcedo C, et al. Emergence of high level azithromycin⁃resistant Neisseria gonorrhoeae strain isolated in Argentina［J］. Sex Transm Dis, 2009,36（12）:787⁃788. doi: 10. 1097/OLQ.0b013e3181b61bb1.<br />
［7］	Unemo M, Shafer WM. Antimicrobial resistance in Neisseria gonorrhoeae in the 21st century: past, evolution, and future［J］. Clin Microbiol Rev, 2014,27（3）:587⁃613. doi: 10.1128/CMR. 00010⁃14.<br />
［8］	Starnino S, Galarza P, Carvallo ME, et al. Retrospective analysis of antimicrobial susceptibility trends （2000⁃2009） in Neisseria gonorrhoeae isolates from countries in Latin America and the Caribbean shows evolving resistance to ciprofloxacin, azithromycin and decreased susceptibility to ceftriaxone［J］. Sex Transm Dis, 2012,39（10）:813⁃821. doi: 10.1097/OLQ.0b013e3182631c9f.<br />
［9］	Bala M, Singh V, Bhargava A, et al. Trends of resistance to antimicrobials recommended currently and in the past for management of gonorrhea in the Apex STD center in India and comparison of antimicrobial resistance profile between 2002⁃2006 and 2007⁃2012［J］. Sex Transm Dis, 2015,42（4）:218⁃222. doi: 10.1097/OLQ.0000000000000261.<br />
［10］	Martin I, Sawatzky P, Liu G, et al. Decline in decreased cephalosporin susceptibility and increase in azithromycin resistance in Neisseria gonorrhoeae, Canada［J］. Emerg Infect Dis, 2016,22（1）:65⁃67. doi: 10.3201/eid2201.151247.<br />
［11］	Jacobsson S, Golparian D, Cole M, et al. WGS analysis and molecular resistance mechanisms of azithromycin⁃resistant （MIC >2 mg/L） Neisseria gonorrhoeae isolates in Europe from 2009 to 2014［J］. J Antimicrob Chemother, 2016,71（11）:3109⁃3116. doi: 10.1093/jac/dkw279.<br />
［12］	Kirkcaldy RD, Kidd S, Weinstock HS, et al. Trends in antimi⁃crobial resistance in Neisseria gonorrhoeae in the USA: the Gonococcal Isolate Surveillance Project （GISP）, January 2006⁃June 2012［J］. Sex Transm Infect, 2013,89 Suppl 4:iv5⁃10. doi: 10.1136/sextrans⁃2013⁃051162.<br />
［13］	Yuan LF, Yin YP, Dai XQ, et al. Resistance to azithromycin of Neisseria gonorrhoeae isolates from 2 cities in China［J］. Sex Transm Dis, 2011,38（8）:764⁃768. doi: 10.1097/OLQ.0b013e318219cdb5.<br />
［14］	Liang JY, Cao WL, Li XD, et al. Azithromycin⁃resistant Neisseria gonorrhoeae isolates in Guangzhou, China （2009-2013）: coevo⁃lution with decreased susceptibilities to ceftriaxone and genetic characteristics［J］. BMC Infect Dis, 2016,16:152. doi: 10.1186/s12879⁃016⁃1469⁃3.<br />
［15］	Xue J, Ni C, Zhou H, et al. Occurrence of high⁃level azithromycin⁃resistant Neisseria gonorrhoeae isolates in China［J］. J Antimicrob Chemother, 2015,70（12）:3404⁃3405. doi: 10.1093/jac/dkv266.<br />
［16］	Ng LK, Martin I, Liu G, et al. Mutation in 23S rRNA associated with macrolide resistance in Neisseria gonorrhoeae［J］. Antimicrob Agents Chemother, 2002,46（9）:3020⁃3025.<br />
［17］	Chisholm SA, Dave J, Ison CA. High⁃level azithromycin resistance occurs in Neisseria gonorrhoeae as a result of a single point mutation in the 23S rRNA genes［J］. Antimicrob Agents Chemother, 2010,54（9）:3812⁃3816. doi: 10.1128/AAC.00309⁃10.<br />
［18］	Demczuk W, Martin I, Peterson S, et al. Genomic epidemiology and molecular resistance mechanisms of azithromycin⁃resistant Neisseria gonorrhoeae in Canada from 1997 to 2014［J］. J Clin Microbiol, 2016,54（5）:1304⁃1313. doi: 10.1128/JCM.03195⁃15.<br />
［19］	Diner EJ, Hayes CS. Recombineering reveals a diverse collection of ribosomal proteins L4 and L22 that confer resistance to macrolide antibiotics［J］. J Mol Biol, 2009,386（2）:300⁃315. doi: 10.1016/j.jmb.2008.12.064.<br />
［20］	Shafer WM, Veal WL, Lee EH, et al. Genetic organization and regulation of antimicrobial efflux systems possessed by Neisseria gonorrhoeae and Neisseria meningitidis［J］. J Mol Microbiol Biotechnol, 2001,3（2）:219⁃224.<br />
［21］	Shigemura K, Osawa K, Miura M, et al. Azithromycin resistance and its mechanism in Neisseria gonorrhoeae strains in Hyogo, Japan［J］. Antimicrob Agents Chemother, 2015,59（5）:2695⁃2699. doi: 10.1128/AAC.04320⁃14.<br />
［22］	Golparian D, Shafer WM, Ohnishi M, et al. Importance of multidrug efflux pumps in the antimicrobial resistance property of clinical multidrug⁃resistant isolates of Neisseria gonorrhoeae［J］. Antimicrob Agents Chemother, 2014,58（6）:3556⁃3559. doi: 10. 1128/AAC.00038⁃14.<br />
［23］	Templeton DJ, Manokaran N, O′Connor CC. Prevalence and predictors of chlamydia co⁃infection among patients infected with gonorrhoea at a sexual health clinic in Sydney［J］. Sex Health, 2012,9（4）:392⁃394. doi: 10.1071/SH11146.<br />
［24］	Chisholm SA, Neal TJ, Alawattegama AB, et al. Emergence of high⁃level azithromycin resistance in Neisseria gonorrhoeae in England and Wales［J］. J Antimicrob Chemother, 2009,64（2）:353⁃358. doi: 10.1093/jac/dkp188.<br />
［25］	Young H, Moyes A, McMillan A. Azithromycin and erythromycin resistant Neisseria gonorrhoeae following treatment with azithro⁃mycin［J］. Int J STD AIDS, 1997,8（5）:299⁃302. doi: 10.1258/0956462971920127.<br />

[1]	康玉英何肖刘勇常慧玲邓起杨元文徐凯郭荣王丽. 急性荨麻疹住院患者185例回顾分析[J]. 中华皮肤科杂志, 2018, 51(3): 224-227.
[2]	展小飞王树椿陈昭李宜儒刘全忠. 不同判愈标准评估阿奇霉素治疗泌尿生殖道沙眼衣原体感染的治愈率[J]. 中华皮肤科杂志, 2012, 45(6): 429-430.
[3]	陈强陈祥生尹跃平. 淋球菌opa基因分型方法的建立与评估[J]. 中华皮肤科杂志, 2011, 44(5): 314-317.
[4]	吴红, 朱道银. 淋球菌营养型与耐药性及质粒的关系[J]. 中华皮肤科杂志, 1998, 31(3): 163-165.
[5]	向辉, 雍刚, 叶梅君, 李绍兴, 周蓉, 廖巫山, 周启贵. 不同时期分离的淋病奈瑟菌药物敏感性测定[J]. 中华皮肤科杂志, 1998, 31(3): 166-167.
[6]	王千秋, 陈平, 苏晓红, 钟铭英, 王海, 叶顺章. 不同地区的淋球菌菌株的营养分型和青霉素敏感性研究[J]. 中华皮肤科杂志, 1996, 29(3): 161-162.
[7]	郑华, 钟淑霞, 张福明, 张林. 多引物聚合酶链反应同时检测沙眼衣原体及解脲支原体和淋球菌[J]. 中华皮肤科杂志, 1996, 29(3): 178-180.
[8]	叶顺章, 王千秋, 张传福, 戴秀芹. 淋球菌营养分型方法的建立和72株淋球菌的分型结果[J]. 中华皮肤科杂志, 1993, 26(3): 139-141.
[9]	周莹, 叶顺章. 淋球菌耐药质粒的提取和限制性酶切分析[J]. 中华皮肤科杂志, 1993, 26(3): 145-146.
[10]	吴喜光, 王冰梅, 蒲卓, 罗庆录, 丰少珍. 八种中药影响淋病奈瑟菌粘附的体外研究[J]. 中华皮肤科杂志, 1992, 25(6): 372-374.
[11]	叶顺章, 熊化保. 54株淋球菌的血清学分型研究[J]. 中华皮肤科杂志, 1992, 25(4): 235-236.