283株淋球菌对七种常见抗菌药物的耐药性分析

Resistance of 283 Neisseria gonorrhoeae strains to seven antimicrobial agents

目的探讨淋球菌对头孢曲松等7种抗菌药物的耐药性,为指导淋病临床治疗提供依据。方法收集2015年1月至2021年12月首都医科大学附属北京地坛医院皮肤性病科临床分离的283株淋球菌,采用琼脂稀释法测定淋球菌对我国淋球菌耐药监测的7种抗菌药物,即大观霉素、头孢曲松、头孢克肟、阿奇霉素、四环素、青霉素和环丙沙星的最低抑菌浓度(MIC),参考世界卫生组织(WHO)及欧洲抗菌药物敏感性试验委员会(EUCAST)的标准判定其敏感性。菌株数和菌株所占比例分别采用频数和率进行统计描述,耐药率的比较采用Pearson卡方检验或Fisher’s确切概率法进行分析。结果283株淋球菌中大观霉素耐药株1株(0.4%),头孢曲松耐药株27株(9.5%),头孢克肟耐药株56株(19.8%),阿奇霉素耐药株39株(13.8%),四环素耐药株279株(98.6%),青霉素耐药株185株(65.4%),环丙沙星耐药株279株(98.6%)。283株淋球菌中同时对四环素、环丙沙星及青霉素耐药菌株为184株(65.0%),其中33株(11.7%)同时对阿奇霉素耐药。大观霉素耐药株(1株)对头孢曲松敏感。头孢曲松耐药株(27株)均对四环素和环丙沙星耐药,其中25株菌同时对头孢克肟耐药。2021年头孢曲松耐药率最高(17.2%),与2016年相比差异有统计学意义(χ^(2)=4.664,P=0.031),与其他年份两两比较差异无统计学意义(P均>0.05)。2021年阿奇霉素耐药率最高(39.7%),与2016至2019年两两比较差异均有统计学意义(2016年:χ^(2)=13.666、P<0.001;2017年:χ^(2)=24.264、P<0.001;2018年:χ^(2)=20.846、P<0.001;2019年:χ^(2)=10.805、P=0.001)。结论头孢曲松和大观霉素可作为淋病一线治疗药物,但仍需密切监测淋球菌的耐药性变化。

Objective To analyze the resistance of Neisseria gonorrhoeae to seven antimicrobial agents such as ceftriaxone,so as to provide basis for clinical treatment of gonorrhea.Methods Total of 283 strains of Neisseria gonorrhoeae were isolated from January 2015 to December 2021 in Department of Dermatology,Beijing Ditan Hospital,Capital Medical University.Minimum inhibitory concentration(MIC)of spectinomycin,ceftriaxone,cefixime,azithromycin,tetracycline,penicillin and ciprofloxacin were determined by agar dilution method.The resistance to these seven antimicrobial agents of Neisseria gonorrhoeae were regularly monitored and the sensitivity was determined according to the World Health Organization(WHO)and European Committee on Antimicrobial Susceptibility Testing(EUCAST)standards.The number and proportion of strains were statistically described by frequency and rate,and the resistance rates between years were compared by Pearson Chi-square test or Fisher’s exact probability method.Results Among the 283 strains,1 strain(0.4%)was resistant to spectinomycin,27 strains(9.5%)were resistant to ceftriaxone,56 strains(19.8%)were resistant to cefixime,39 strains(13.8%)were resistant to azithromycin,279 strains(98.6%)were resistant to tetracycline,185 strains(65.4%)were resistant to penicillin and 279 strains(98.6%)were resistant to ciprofloxacin.Among the 283 strains,184 strains(65.0%)were multidrugresistant to tetracycline,ciprofloxacin and penicillin,among which 33 strains(11.7%)were resistant to azithromycin.The spectinomycin-resistant strain was sensitive to ceftriaxone.All ceftriaxone-resistant strains were multidrug-resistant to tetracycline and ciprofloxacin,among which 25 strains were resistant to cefixime.The resistance rate of ceftriaxone in 2021 was the highest(17.2%),and the difference was statistically significant compared with that of 2016(χ^(2)=4.664,P=0.031),but there was no statistically significant difference compared with other years(all P>0.05).The resistance rate of azithromycin in 2021 was the highest(39.7%),and the difference was statistically significant compared with those of 2016 to 2019(2016:χ^(2)=13.666,P<0.001;2017:χ^(2)=24.264,P<0.001;2018:χ^(2)=20.846,P<0.001;2019:χ^(2)=10.805,P=0.001).Conclusions Ceftriaxone and spectinomycin can be used as first-line treatment for gonorrhea,but the trend of antimicrobial resistance of Neisseria gonorrhoeae needs to be regularly monitored.