2017—2018年江苏省淋球菌药物敏感性分析

Analysis of antibiotic susceptibility of Neisseria gonorrhoeae in Jiangsu province from 2017 to 2018

目的了解江苏省近年淋球菌临床分离株对常用抗菌药物的药物敏感性。方法采用琼脂稀释法,检测2017—2018年全省收集的207株淋球菌临床分离株,测定青霉素、四环素、大观霉素、头孢曲松、阿奇霉素和环丙沙星等6种抗菌药物的最小抑菌浓度(MIC),并判定其药物敏感性及质粒介导的高度耐四环素淋球菌(TRNG)。采用纸片酸度法检测产β-内酰胺酶淋球菌(PPNG)菌株。结果207株淋球菌临床分离株,复苏成功157株,复苏成功率75.84%,其中78.98%对青霉素耐药(124/157),包括PPNG阳性72株(45.86%);对四环素耐药率为100.00%,其中TRNG阳性率为30.57%;对环丙沙星、阿奇霉素耐药率分别为99.36%、11.46%;未发现对大观霉素和头孢曲松耐药菌株,7.64%为头孢曲松低敏菌株。各市TRNG阳性率差异有统计学意义(P<0.001),PPNG阳性率差异无统计学意义(P>0.05)。共有4种多重耐药模式,以(环丙沙星+青霉素+四环素)耐药模式为主,多重耐药率为78.34%;(环丙沙星+青霉素+四环素+阿奇霉素)四重耐药率为8.92%。结论江苏地区淋球菌临床分离株普遍对青霉素、环丙沙星、四环素耐药,临床治疗建议使用阿奇霉素、大观霉素和头孢曲松,并需定期监测其耐药性变化。

Objective To survey the antibiotic susceptibility of Neisseria gonorrhoeae clinical isolated strains from 2017 to 2018 in Jiangsu province in recent years.Methods The minimum inhibitory concentrations(MIC)of Neisseria gonorrhoeae isolates for 6 antibiotics including penicillin,tetracycline,azithromycin,ciprofloxacin,spectinomycin and ceftriaxone,were determined by the agar dilution method.The results of MIC were interpreted to show the antibiotic susceptibility and plasmid mediated high tetracycline resistant Neisseria gonorrhoeae(TRNG).Penicillinase producing Neisseria gonorrhoeae(PPNG)isolate was detected by the paper acidimetric method.Results A total of 207 Neisseria gonorrhoeae clinical isolates were collected and 157 were successful resuscitated,resluting resuscitation rate of 75.84%.Among which 78.98%(124/157)isolates were resistant to penicillin,including 72 PPNG strains(45.86%).The resistant rate to tetracycline was 100.00% and TRNG accounted for 30.57%.The resistance rates to ciprofloxacin and azithromycin were 99.36% and 11.46%,respectively.No isolates were resistant to spectinomycin or ceftriaxone,but 7.64% isolates were hypoallergenic to ceftriaxone.Among different surveillence cities,the TRNG positive rates were statistically different(P<0.001)while the PPNG postitive rates showed no significant difference(P>0.05).There were 4 multi-drug resistance pattern,ciprofloxacin+penicillin+tetracycline were major pattern,the multi-drug resistant rate was 78.34%.The quadruple drug resistant rate of(ciprofloxacin+penicillin+tetracycline+azithromycin)was 8.92%.Conclusion Clinical isolates of Neisseria gonorrhoeae in Jiangsu province showed high level resistance to penicillin,ciprofloxacin and tetracycline,which suggests to use azithromycin,spectinomycin and ceftriaxone for clinical treatement for gonorrhea.The regular surveillance for antibiotic susceptibility should be conducted.