女性泌尿生殖道感染脲原体对4种大环内酯类抗生素的耐药性研究

Study on drug resistance of Ureaplasma to four kinds of macrolide antibiotics in female urogenital tract infection

目的了解近3年来上海地区女性泌尿生殖道疑似感染患者支原体的感染情况、脲原体对4种大环内酯类抗生素的耐药和交叉耐药性,为临床抗菌药物的合理使用提供参考。方法以2013-2015年在武警上海总队医院就诊的25 606例女性泌尿生殖道疑似感染患者为研究对象,采用固体-液体培养基联合检测对宫颈分泌物标本中的脲原体和人型支原体进行培养、鉴定和药敏试验。结果该地区女性泌尿生殖道疑似感染患者脲原体和人型支原体的总检出率为65.3%,以脲原体为主（44.5%）。支原体感染的年龄主要集中在21～25岁和26～30年龄段,分别为28.7%和33.6%。在4种抗菌药物中,对脲原体耐药率最高的是阿奇霉素（45.4%）,其次是罗红霉素（21.0%）,克拉霉素（7.6%）和交沙霉素（1.8%）。两种抗生素间交叉耐药率最高的是罗红霉素和阿奇霉素为18.6%,最低的是交沙霉素和克拉霉素为1.1%,4种药物全部耐药的占0.8%。结论该地区女性泌尿生殖道感染患者支原体检出率非常高,且以脲原体为主,感染多集中在21～25岁和26～30岁,而且呈年轻化趋势。脲原体对14和15元环大环内酯类抗生素的耐药率比较高,尤其是阿奇霉素已不适合一线药物,对16元环交沙霉素的耐药率较低,药物之间存在一定的交叉耐药率,可能存在较多的耐药机制。

Objective To investigate Mycoplasma infection status,drug resistance and cross drug resistence of Ureaplasma to four kinds of macrolide antibiotics among the female patients suspected of urogenital tract infection in Shanghai city in recent three years,provide reference for reasonable use of antibiotics. Methods A total of 25 606 female patients suspected of urogenital tract infection were selected from the hospital from 2013 to 2015,solid culture medium and liquid culture medium were used to culture Ureaplasma and Mycoplasma hominis（ Mh） in cervical sections,identification and drug sensitive test were conducted. Results The total detection rate of Ureaplasma and Mh among female patients suspected of urogenital tract infection in Shanghai city was 65. 3%,Ureaplasma infection（ 44. 5%） was predominant. The high risk age ranges of Ureaplasma infection were 21-25 and 26-30 years old,the infection rates were 28. 7% and 33. 6%,respectively. Among four kinds of antibiotics,the drug resistance of Ureaplasma to azithromycin was the highest（ 45. 4%）,followed by roxithromycin（ 21. 0%）,clarithromycin（ 7. 6%）,and josamycin（ 1. 8%）. The cross resistance of roxithromycin and azithromycin was the highest（ 18. 6%）,the cross resistance of josamycin and clarithromycin was the lowest（ 1. 1%）,the proportion of drug resistance to the four antibiotics was 0. 8%. Conclusion The detection rate of Mycoplasma among female patients with urogenital tract infection in Shanghai city is high,Ureaplasma is the main infection type,the high risk age ranges are 21-25 and 26-30 years old,showing a trend of younger. The drug resistance of Ureaplasma to 14-membered-ring and 15-membered-ring macrolide antibiotics is high,azithromycin is not suitable for clinical first-line treatment. The drug resistance of Ureaplasma to 16-membered-ring macrolide antibiotic（ josamycin） is low,there is cross resistance among different kinds of macrolide antibiotics,multiple mechanisms of drug resistance may exist.