西安地区2002-2009年淋球菌耐药性趋势分析

Trend analysis of antibiotic resistance in Neisseria gonorrhoeae in Xi＇an region, 2002--2009

目的监测西安地区淋球菌对抗生素的耐药性及产青霉素酶（PPNG）和质粒介导的耐四环素菌株（TRNG），了解淋球菌耐药趋势。方法2002—2009年从性病门诊确诊的淋病患者中分离647株淋球菌。采用琼脂稀释法检测菌株是否为TRNG及对抗生素最低抑菌浓度（MIc），采用纸片酸度法测定菌株是否产β-内酰胺酶（PPNG）。结果647株淋球菌中，检出216株（33．4％）TRNG，PPNG为290株（44．8％）。TRNG的阳性率保持在28．3％-49．2％，只有2005年阳性率是17．3％。PPNG阳性率由2002年的37．1％上升到2005年的64％，呈递增趋势，但2006-2009年又逐年下降，2009年下降到32．3％。大观霉素的耐药率为0—2．8％。环丙沙星的耐药率除2006年（51％）有所下降以外，其余均在80％以上，2005年达到100％。头孢曲松的耐药率除2003年发现4株耐药外，其余无耐药株出现，但敏感菌株逐渐减少，中敏菌株逐年递增。结论淋球菌对大观霉素敏感性高，应做为治疗淋病的首选药物，头孢曲松治疗淋病应注意给足剂量，环丙沙星不能做为治疗淋病用药。

Objective To monitor the antibiotic resistance in Neisseria gonon＇hoeae, determine the prevalence of penicillinase-producing Neisseria gonorrboeae （PPNG） and plasmid-mediated tetracycline- resistant NeisseHa gonorrhoeae （TRNG） in Xi＇an region, and to analyse the trends in antibiotic resistance in Neisseffa gonorrhoeae. Methods In total, 647 strains of Neisseria gonorrhoeae were isolated from patients with gonorrhea in sexually transmitted disease （STD） clinic settings from 2002 to 2009. Agar dilution method was used to detect TRNG and determine the minimal inhibitory concentration （MIC） of antibiotics, and paper acidometric method to detect PPNG. Results Of these 647 strains, 216 （33.4%） were TRNG, 290 （44.8%） were PPNG. The prevalence of TRNG strains remained between 28.3% and 49.2% in 2002--2009, except for 17.3% in 2005; the prevalence of PPNG strains increased from 37.1% in 2002 to 64% in 2005, but declined from 2006 to 2009 （32.3%）. The prevalence of resistance to spectinomycin maintained at alow level （0 to 2.8%） over these years, while that to ciprofloxacin remained higher than 80% from 2002 to 2009, and accounted for 100% in 2005, with the exception of 51% in 2006. Ceftriaxone resistance was observed in none of these strains except 4 isolates in 2003, but the susceptibility to ceftriaxone decreased yearly. Conclusions Neisseffa gonozrhoeae is highly sensitive to spectinomycin, which should serve as the first treatment choice for gonorrhea. Full dose is necessary for the application of ceftriaxone in the treatment of gonorrhea. Ciprofloxacin should not be used to treat gonorrhea.