金黄色葡萄球菌中红霉素对克林霉素诱导耐药的研究

Study of inducible resistance of erythromycin to clindamycin in staphyloccus aureus

目的:了解我院临床分离的金黄色葡萄球菌中红霉素和克林霉素的耐药情况以及检测克林霉素诱导型耐药的发生率。方法:按照2007年美国临床实验室标准化研究所(CLSI)推荐的纸片扩散法,检测耐甲氧西林金黄色葡萄球菌(MRSA)及金黄色葡萄球菌中红霉素和克林霉素的耐药性,并用双纸片法(即D试验)检测红霉素对克林霉素诱导性耐药。结果:金黄色葡萄球菌中MRSA占71.7%(297/414),红霉素、克林霉素同时耐药菌株在耐甲氧西林金黄色葡萄球菌(MRSA)和甲氧西林敏感金黄色葡萄球菌(MSSA)中分别占60.9%(181/297)和52.9%(62/117),对红霉素耐药而克林霉素敏感的MRSA和MSSA中,D试验阳性分别为62.7%和64.5%。D试验阳性占所测金黄色葡萄球菌的20.3%,占红霉素耐药而克林霉素敏感的金黄色葡萄球菌的63.2%。结论:临床微生物实验室应开展D试验,检测金黄色葡萄球菌中红霉素对克林霉素的诱导性耐药,可以指导临床医师合理选用大环内酯类、林克酰胺类抗生素。

Objective：To investigate the resistance of Staphylococcus aureus to clindamycin and erythromycin and detect the incidence of the inducible clindamycin resistance.Methods：We used the disk diffusion method（CLSI 2007）,to detect the resistance of MRSA and staphylococcus aureus to clindamycin and erythromycin.The double-disk diffusion method（D-test） was employed to detect erythromycin-induced clindamycin resistance.Results：MRSA was 71.7%（297/414） in Staphylococcus aureus,the co-resistance stains to erythromycin and clindamycin was 60.9%（181/297）in MRSA and 52.9%（62/117）in MSSA,resistance to erythromycin and clindamycin-sensitive in MSSA and MRSA,the positive rate of D-test was 62.7% and 64.5%.The positive rate of D-test was 20.3% in Staphylococcus aureus,D-test positive stains was 63.2% in resistance to erythromycin and clindamycin-sensitive strains.Conclusion：D-test should be implemented in clinical microbiological laboratory.To detect the Erythromycininduced resistance to clindamycin in Staphylococcus aureus can guide clinicians to rationally prescribe macrolides and link amide antibiotics to patients.