广州地区淋球菌耐药性的趋势分析

Trends of antimicrobial resistance in Neisseria gonorrhoeae isolated from Guangzhou

目的了解广州地区13年的产青霉素酶淋球菌（PPNG）和高水平耐四环素淋球菌（TRNG）的流行状况及对5种抗菌药物的耐药趋势。方法用琼脂稀释法测定最低抑菌浓度（MIC）以及用纸片碘量法检测β-内酰胺酶。结果 1 324株淋球菌中,2000-2005年度PPNG检出率占23.5%（156/665）,2008-2014年度PPNG检出率占36.4%（240/659）,差异有统计学意义（P〈0.05）。2000-2005年度TRNG检出率占33.4%（222/665）,2008-2014年度TRNG检出率占42.6%（281/659）,差异有统计学意义（P〈0.05）。青霉素耐药率从71.1%（473/665）升高至87.1%（574/659）,差异有统计学意义（P〈0.05）;环丙沙星耐药率由88.9%（591/665）升至98.0%（646/659）,差异有统计学意义（P〈0.05）;头孢曲松中度敏感率从12.3%（82/665）提升到21.5%（142/659）,差异有统计学意义（P〈0.05）;大观霉素未发现耐药菌。结论持续进行淋球菌耐药性监测非常重要,大观霉素在临床上可以作为治疗淋病的优选药物,具有良好疗效。

Objective To investigate,in the past thirteen years,the developing trends of resistance of Neisseria gonorrhoeae to 5antibiotics and the prevalence of penicillinase-producing Neisseria gonorrhoeae（PPNG）and high level tetracycline resistant Neisseria gonorrhoeae（TRNG）.Methods Minimum inhibitory concentration（MIC）to ceftriaxone,spectiomycin,ciprofloxacin,and Penicillin were determined using the agar dilution method,andβ-lactamase by paper iodine quantitative method.Results A total of1 324 Neisseria gonorrhoeae isolates were studied,including 665 samples from 2000 to 2005and 659 samples from 2008 to 2014.Between 2000-2005 and 2008-2014,the rates of PPNG and TRNG isolates significantly increased from 23.5%（156/665）to 36.4%（240/659）,the difference was statistically significant（P0.05）and from 33.4%（222/665）to 42.6%（281/659）,the difference was statistically significant（P0.05）respectively.The proportion of resistant strains to penicillin remarkably rose from 71.1%（473/665）to 87.1%（574/659）,the difference was statistically significant（P0.05）.Like penicillin,the percentage of resistant strains to ciprofloxacin significantly increased from 88.9%（591/665）to 98.0%（646/659）,the difference was statistically significant（P0.05）.Intermediate susceptible isolates to ceftriaxone increased from 12.3%（82/665）to 21.5%（142/659）,the difference was statistically significant（P0.05）.No isolates resistant to spectinomycin were identified over the years.Conclusion The study shows that it is important to strengthen the Neisseria gonorrhoeae surveillance of antimicrobial resistance as well as spectinomycin is successively as first drug of choice for treatment of Neisseria gonorrhoeae.