淋球菌、支原体和沙眼衣原体在急性尿道炎中的感染分布及耐药性分析

Distribution and Drug Resistance of Neisseria Gonorrhoea, Mycoplasma, and Chlamydia Trachomatis in Acute Urethritis

目的了解淋球菌、支原体和沙眼衣原体在急性尿道炎中的感染分布和耐药情况。方法用培养法对淋球菌和支原体进行分离鉴定和药敏试验,用头孢硝噻吩法对淋球菌进行β-内酰胺酶检测,用单克隆抗体胶体金标法测定沙眼衣原体。支原体药敏试验用支原体药敏试剂盒检测,淋球菌药敏试验采用中K-B法。结果在389份尿道口分泌物标本中,阳性分离率为94.6%。淋球菌β-内酰胺酶的产生率为29.0%,对青霉素的敏感率为2.9%,对氧氟沙星和环丙沙星的敏感率为6.8%和7.2%,对壮观霉素、头孢菌素和头孢西丁的敏感性均较高。支原体对乙酰螺旋霉素、红霉素、环丙沙星、左氧氟沙星和司巴沙星以及壮观霉素的敏感率均不超过50.0%,而对四环素、强力霉素、罗红霉素、美满霉素、交沙霉素和阿奇霉素的敏感率均超过70.0%。结论急性尿道炎患者主要以淋球菌感染为主,支原体和沙眼衣原体可引起混合感染。监测淋球菌和支原体的耐药性对指导临床合理使用抗生素有重要意义。

Objective To investigate the distribution and drug resistance of Neisseria gonorrhoea, Mycoplasma and Chlamydia trachomatis in patients with acute urethritis. Methods Cultural identification and drug susceptibility tests were performed. The nitrocefin test was uesd to detect the β- lactamase in Neisseria genorrhceae strains. Chlamydia trachomatis was identificated by a monoclonal gold labeled antibody method. Results A total of 389 specimens were examined and the positive isolation rate was 94.6%. The prevalence of β lactamase production among Neisseria genorrhoeae isolates was 29.0%. The percentages of susceptibility of Neisseria gonorrhoeae strains were 2.9% to penicillin and 7.2% to ciprofloxacin and 6.8% to ofloxacin respectively, but the susceptibility to spectinomycin, cephalosporin and cefoxitin was high. The resistant rates of Mycoplasma to acetylspiramycin, erythromycin, ciprofloxacin, levofloxacin, sparfloxacin and spectinomycin were more than 50.0%, but the susceptibilities to tetracycline ,roxithromycin, doxycyclin, minocyclin, josamycin, and azithromycin were about more than 70.0 %. Conclusions Neisseria gonorrhoeae is the main pathogen in patients with acute urethritis and the mixed infections are induced by superinfection of Mycoplasma and/or Chlamydia trachomatis. It is important to test the drug susceptibility of Neisseria gonorrhoeae and Mycoplasma to guide the use of correct antibiotics.