慢性阻塞性肺病耐药肺炎链球菌基因检测及耐药现状分析

Gene detection and drug resistance analysis of COPD resistant Streptococcus pneumoniae

目的对本院慢性阻塞性肺病(chronic obstructive pulmonary disease,COPD)肺炎链球菌感染者的血清型和耐药性进行了定量分析。方法从2015年10月-2019年5月,在本院收集了284株来自稳定COPD患者的肺炎球菌分离株。所有菌株均通过Quellung反应进行血清分型。使用Epsilomer药物敏感试验条和Kirby-Bauer纸片法进行了药敏试验。使用PCR对大环内酯类药物耐药的基因erm B和mef A进行检测。结果 217株非侵袭性菌株中,PCV7和PCV10的覆盖率为47.9%(104/217)、53.9%(117/217);PCV13的覆盖率为86.2%(187/217),明显高于PCV7和PCV10(P<0.001)。所有菌株均对红霉素耐药,最低抑菌浓度> 256μg/ml,对万古霉素、左氧氟沙星和利福平敏感。所有菌株的多药耐药率为98.2%(279/284)。在所有菌株中检测到erm B基因,其中38.4%(109/284)同时携带mef A基因。携带mef A和erm B的菌株在19F(86.5%)和19A(92.3%)中检出率较高。结论 PCV13可能在预防肺炎球菌病和控制多药耐药方面发挥着最重要的作用。

Objective To investigate the serotype distribution and antimicrobial susceptibility of chronic obstructive pulmonary disease(COPD)patients with Streptococcus pneumoniae infection.Methods A total of 284 clinical pneumococcal isolates from COPD patients with Streptococcus pneumoniae infection were collected between October 2015 and May 2019.All strains were serotyped by Quellung reaction.The epsilomer drug sensitivity test strip and Kirby Bauer paper method were used for drug sensitivity test.The resistance genes erm B and mef A of macrolides were detected by PCR.Results In 217 noninvasive strains,the coverage of PCV7 and PCV10 was 47.9%(104/217),53.9%(117/217)and that of PCV13 was 86.2%(187/217),significantly higher than that of PCV7 and PCV10(P<0.001).All the strains were resistant to erythromycin,and the minimum inhibitory concentration was more than 256μg/ml,which were sensitive to vancomycin,levofloxacin and rifampin.The multidrug resistance rate of all strains was 98.2%(279/284).Erm B gene was detected in all strains,of which 38.4%(109/284)carried mef A gene at the same time.The strains carrying mef A and erm B had the highest detection rate in 19 F(86.5%)and19 A(92.3%).Conclusion PCV13 may play the most important role in the prevention of pneumococcal disease and control of multidrug resistance.