合理选择抗菌药物进行淋病奈瑟菌药敏试验

The Importance of Properly Selecting Antibacterial Agents for Testing Neisseria Gonorrhoeae

目的 :对淋病奈瑟菌 (NG)药敏结果进行分析 ,探讨判定尺度可能造成的误差。 方法 :145株淋病奈瑟菌采用美国临床实验室标准化委员会 (NCCLS)规范的纸片扩散法进行药敏试验 ,抗菌药物选用NCCLS推荐的有NG敏感界点的药物 7种和无NG敏感界点的药物 7种。 结果 :有NG敏感界点的头孢三嗪 (CTR)和头孢噻肟 (CTX)敏感率分别为 5 2 .4%和 5 5 .1% ,头孢呋辛钠 (CFX)为 2 9.0 % ,环丙沙星 (CIP)和氧氟沙星 (OFX)均为 5 .5 % ,青霉素(PEN)和四环素均耐药 ;无NG敏感界点的头孢唑啉 (CFZ)敏感率 92 .0 % ,阿齐霉素 (AZM) 88.3 % ,红霉素 (ERY)71.0 % ,氨苄西林 (AMP) 6 2 .8% ,庆大霉素 (GEM) 5 4.5 % ,阿米卡星 (AMK) 30 .3% ,诺氟沙星 (NOR) 12 .4%。 结论 :NG主要侵犯生殖道粘膜上皮细胞 ,抗菌药物对NG判定敏感的抑菌圈直径比其他细菌大 ,可能与局部药物浓度较低有关 ,因而常规药敏试验应选有NG界点的抗菌药物 ,否则会误导临床用药。

Objectives: To analyse the antimicrobial susceptibility results of Neisseria gonorrhoeae (NG) and evaluate the errors which may be caused by using different criteria. Methods: The antibiotics sensitive test standard specified by NCCLS was used for 145 strains of NG. Seven antibiotics with NG critical points and another seven without NG critical points were selected for these tests. Results: The sensitivity rates of the former were like those of 52.4%(CTX), 52.4%(CTR), 29.0%(CFX), 5.5%(CIP and OFX), respectively, while PEN and TET were both zero. The sensitivity rates of the latter were as follows: 92.0%(CFZ), 88.3%(AZM), 63.8%(AWP), 71.0%(ERY), 54.5%(GEM), 30.3%(AMK)and 12.4%(NOR), respectively. Conclusions: NG primarily invade epithelial cells of genital tract mucous. The diameter of the inhibition zone for determining the sensitivity of NG to the medicine is bigger than those of other germs. This may be related to low local concentration of the medicine. Therefore, the routine sensitivity test should be done only on the antibiotics with NG critical point of sensitivity. Otherwise it would be misleading to clinical administration.