洛阳地区男性泌尿生殖道支原体感染流行病学调查及耐药性变迁

The epidemiology and drug-resistance evolution of mycoplasma infection in male urogenital tract of the Luoyang areas

目的研究男性泌尿生殖系统炎症患者解脲支原体(UU)和人型支原体(MH)感染及对抗菌药物耐药情况的变迁,以了解本地区男性支原体的感染流行状况并指导临床合理选择使用抗菌药物。方法采用病原培养法和PCR方法对2009年1月～12月在我院门诊就诊的450例泌尿生殖系统炎症患者泌尿生殖道标本进行UU和MH检测,同时进行体外药物敏感试验,并与2000年进行比较,对UU和MH的感染及体外药物敏感性的变化情况进行分析。结果 2000年131例高危人群检测结果中UU46例占35.1%,MH18例占13.7%,UU和MH混合感染24例占18.3%;2009年450例高危人群检测结果中UU151例占33.6%,MH60例占13.3%,UU和MH混合感染78例占17.3%。2009年与2000年相比,男性泌尿生殖系统UU和MH对可乐比妥和阿奇霉素的耐药率明显增高,对交沙霉素的耐药率有所改善,而强力霉素和美满霉素的耐药率相对稳定;敏感性较高的依次是强力霉素、美满霉素和交沙霉素。结论 UU和MH已成为男性泌尿生殖系统炎症的主要病原体且以UU为主。男性泌尿生殖系统感染患者的就医人数2009年比2000年显著增多,提示人们的自我保护意识明显加强。2009年与2000年相比,UU、MH的感染率以及UU和MH的混合感染率虽然变化不大,但一段时间以来都维持在较高的水平,应引起人们的高度重视。UU和MH的耐药率较高,且随着时间的变化其耐药性也随之改变。因此,临床治疗支原体感染时应尽量根据药敏结果选择敏感药物。强力霉素、美满霉素和交沙霉素可作为本地区临床经验用药的首选药物。

This study aimed to investigate the UU and MH infection of male urogenital system and its drug-resistance evolution,for guiding the reasonable choice of the clinical medicine.We employed PCR to detect UU and MH in the samples from 450 mycoplasma infection patients diagnosed in 2009,as well as detected the drug sensitivity in vitro.Then these results were compared with those of 131 patients diagnosed in 2000.We found that in patients of 2000,35.1% were infected with UU（46 cases）,13.7% with MH（18 cases）,and 18.3% with both UU and MH（24 cases）.Of the 450 mycoplasma positive patients in 2009,33.6% were infected with UU（151 cases）,13.3% with MH（60 cases）,and 17.3% with both UU and MH（78 cases）.Compared with patients of 2000,the drug-resistance against CRA and AZI raised obviously in patients of 2009,and the drug-resistance against josamycin（JOS） was improved,while the drug-resistance rates to DOX and MIN did not change significantly.The rank of the drug sensitivity rate is DOX,MIN,and JOS.In conclusion,UU and MH had become the major pathogens of male NGU,especially UU.The obviousl increase with the patients of UU and MH infection points out that the improvement of patients＇ self-protect consciousness.Although the rates of UU/MH infection and mix infection have not change significantly,the positive rate of mycoplasma has been a high level among a long period,therefore attention should be paid.UU and MH infection have showed high drug-resistance,which changes with time.Our study also implies that the treatment for mycoplasma should be based of drug sensitivity tests;and DOX,MIN and JOS may be used as the local first choice.