保定市肺炎链球菌基因分型与耐药性研究

Genotyping and drug resistance of Streptococcus pneumoniae in Baoding City

目的了解保定市肺炎链球菌血清型和耐药性特征,指导临床用药。方法收集2013-2015年保定市3家医院临床分离的非重复性肺炎链球菌210株,对这些菌株采用多重PCR方法进行分型,再用K-B法判定药物的敏感性,分析不同血清型SP的耐药性。结果 210株肺炎链球菌菌型主要有4种,分别为血清型19F(30.0%)、19A(16.7%)、6A/6B(11.0%)、5(5.2%)。≤5岁年龄组患者PRSP(口服折点)的发生率最高达到48.4%,其阿莫西林耐药率高于其他年龄组(20.0%、17.6%),差异有统计学意义(χ2=6.103,P<0.05)。不同年龄组对氟喹诺酮类药物都保持很高的敏感率(100.0%)。血清型19F和19A的PNSP菌株对阿莫西林、头孢曲松的不敏感率显著大于PSSP菌株(P<0.05);19F、19A、6A/6B和5型对美罗培南的不敏感率PNSP菌株均显著大于PSSP菌株(P<0.05)。左氧氟沙星、氧氟沙星、万古霉素、莫西沙星对各血清型都有很高的敏感性。结论目前SP耐药形式严峻,应及时监控肺炎链球菌的血清分型和耐药性变化。

Objective To investigate the characteristics of serum type and drug resistance of Streptococcus pneumonia in Baoding City,and to provide the basis for the clinical treatment.Methods 210 clinical isolates of non-repetitive Streptococcus pneumonia from 3 hospitals of Baoding City from 2013 to 2015 were performed by multiple PCR method analyzed the sensitivity of drug substance by K-B method,and then analyzed the drug resistance of S p in this region.Results The most prevalent serum types of 210 isolates were 19F（30.0%）,19A（16.7%）,6A/6B（11.0%）,5（5.2%）.Occurring rate of less than 5 years old patient group reached 48.4%.The resistant rate of amoxicillin in less than 5 years old group was higher than that of the two other age group（20.0%,17.6%）（χ^2= 6.103,P〈0.05）.The sensitive rate of fluoroquinolone drugs（left ofloxacin,levofloxacin,moxifloxacin） of different age groups remained very high（100.0%）.Non-sensitive rate to amoxicillin ceftriaxone of 19 F and 19 A PNSP stranins（P〈0.05）.Non-sensitive rate to meropenem of 19 F,19A,6A/6B and 5 PNSP strains was significantly higher than that of PSSP strains（P〈0.05）.Levofloxacin,ofloxacin,vancomycin,moxifloxacin has a high sensitivity for each serotype.Conclusion At present,it is in severe form of the S p drug resistance,it should be timely to monitor the changes of serum typing and drug resistance of Streptococcus pneumoniae.