肺炎支原体培养及药敏试验和耐药基因分析

Pneumonia mycoplasma culture and drug sensitive test and drug-resistant genetic analysis

目的:分析肺炎患者肺炎支原体感染状况及其耐药和耐药基因特点。方法:使用肺炎支原体试剂盒,对2011年1月-2012年12月收治的582例呼吸道感染的患者的咽拭子进行肺炎支原体培养及药敏试验。采用实时PCR对培养出来肺炎支原体菌株与大环内酯类抗生素耐药性密切相关的mefA、mefE和ermB基因检测分析。结果:肺炎支原体培养阳性128例,总阳性率22.0%;男、女比较差异无统计学意义(P>0.05);不同年龄段感染比较,差异有统计学意义(P>0.05)。药敏试验:罗红霉素的耐药性最高58.6%(75例),对罗红霉素耐药的肺炎支原体耐药基因mefA、mefE和ermB的阳性率分别为20.5%(15例)、45.3%(34例)和93.3%(70例),对罗红霉素敏感的肺炎支原体耐药基因mefA、mefE和ermB的阳性率分别为2.6%(1例)、5.1%(2例)和7.7%(3例);耐药基因比较差异有统计学意义(P>0.05)。结论:肺炎支原体是呼吸道感染的重要病原体,肺炎支原体在临床耐药情况日趋严重,最常见的耐药机制是ErmB介导的靶位改变,mef介导外排机制也较多,应根据药敏试验结果指导临床合理用药,使患者得到正确及时有效的治疗。

Objective ：Analyze the Mycoplasma pneumoniae infection of the pneumonia patients and their resistance gene features.Methods： By Using the reagents and boxes agents of Mycoplasma pneumoniae produced by Zhuhai Black Horse Biological Engineering Co.,Ltd,the susceptibility testing of throat swabs among 582 Respiratory tract infections samples and cultivated their Mycoplasma pneumoniae in our hospital which were ac cepted from Jan.2011 to Dec.2012.We used real time PCR to analyze the gene mefA,mefE and ermB which closely related with the Mycoplasma pneumoniae strains and Macrolide antibiotics resistance.Results ：There are 128 masculine Mycoplasma pneumoniae and is 22 percent of total masculine rate.The rate of male infections is 23.3 percent（68 samples） and female is 20.7 percent（60 samples） among the whole samples.There is no statistics significance of the gender differences（P＆gt;0.05）.Age： The infection of three months to 14 years old is 26.4 percent（102 samples）,older than 15 years is 13.3 percent（26 samples）.There is statistics significance between the different ages.Susceptibility testing： The resistance of Roxithromycin is the highest,58.6 percent（75 samples）.Josamycin is the lowest,2.3 percent（12 samples）.Minocycline is the second lowest,5.5 percent（7 samples）.Doxycycline is the third lowest,9.4 percent（3 samples）.The gene mefA,mefE and ermB’s masculine rates of Roxithromycin resistance are 20.5 percent（15 samples）,45.3 percent（34 samples） and 93.3 percent（70 samples）.The gene mefA,mefE and ermB’s masculine rates of Roxithromycin sensitive are 2.6 percent（1 samples）,5.1 percent（2 samples） and 7.7 percent（3 samples）,There is statistics significance between the different resistance genes（P＆gt;0.05）.Conclusion： Mycoplasma pneumoniae is an important pathogeny of respiratory tract infection.The Mycoplasma pneumoniae resistance is becoming serious in clinic.The most normal resistance mechanism is target changing which mediated by ermB,and there is a lot of efflux mechanism which mediated by mef.The doctors had better use the medicines with the guidance of susceptibility testing results in reason,so that the patients can be effectively cured in time.