深圳地区支原体对抗生素耐药性变迁的研究

The Vicissitudes of Mycoplasma's Antibiotic-resistance in Shenzhen

目的 为探讨深圳地区 2 0 0 0～ 2 0 0 2年间支原体对抗生素耐药性变迁 ,更好为临床对支原体感染者合理用药 ,提供可靠依据。并对支原体感染初诊和复诊者 ,进行耐药性比较 ,以避免抗生素烂用和反复感染。而使抗生素使用能更合理。 方法 我们采用肉汤稀释法 ,先后对 16 0 2株支原体 (Uu.Mh)进行 4类型 14种抗生素耐药性监测 ,并将三年结果进行比较分析。将分离出 16 0 2株支原体经三次传代成纯培养物后接种于液体培养基 ,置烛缸 37℃培养 2 4～ 4 8h,检测其耐药性。 结果 连续三年监测 ,支原体对大多数抗生素耐药性呈逐年上升趋势 ,有少部分抗生素比较稳定。解脲支原体 (Uu)和人型支原体 (Mh)耐药率差异显著 (P<0 .0 1)。 U u耐药率最高是培氟沙星达 6 5 .70 % ,最低是交沙霉素 2 .33%。而 Mh耐药率最高是罗红霉素 .阿奇霉素 2 8.4 9% ;最低是培氟沙星耐药率 1.30 %。复诊患者耐药性高于初诊患者 ,差异显著 (P<0 .0 1)。 结论 支原体耐药性逐年上升原因有 3点 :(1)临床医生凭经验滥用抗生素造成 ,(2 ) Uu感染者若用药不当 ,不仅治疗无效 ,反而会诱导 Uu产生 Mh,造成混合感染可使耐药性提高 ,(3)混合感染往往出现多重耐药。建议 :临床医生凡疑为支原体感染者 ,都做支原体培养、鉴定、分型及体外药?

Objective The vicissitudes of Mycoplasma's antibiotic-resistance between 2000 and 2002 in Shenzhen was explored. The antibiotic-resistance between Mycoplasma's preliminary diagnosis and it's reexamination was compared so as to provide reliable evidence for the reasonable drug use and avoid the abuse of antibiotics and the repeated infection. Methods Adopting the broth dilution, we supervised the antibiotic-resistance of 1062 strains of Mycoplasma successively, and analyzed the results of the three years'. After three passage cultivation, we inoculated the pure-culture to fluid medium, cultivated them for 24-48 hours under 37 centigrade, and detected their antibiotic-resistance. Result To the majority of antibiotics, the resistance rate of Mycoplasma increased during the three years. The difference of resistance rate between Mh and Uu has statistical significance. In Uu, the highest resistance rate is to Pefloxacin, which is 65.70%, and the lowest resistance rate is to Josamycin(2.33%); In Mh, the highest resistance rate is to Roxithromycin, which is 28.49%, and the lowest one is to Pefloxacin(1.30%). The antibiotic-resistance rate of Mycoplasma's reexamination is higher than that of the Mycoplasma's preliminary diagnosis. Conclusion The antibiotic-resistance rate of Mycoplasma increased year by year. It has three main reasons: (1)the abuse of antibiotics;(2)the inappropriate drug use in Uu infectors, which can result in mix-infection with Mh;(3)the appearance of multi antibiotic-resistance. We suggest that when Mycoplasma infection is suspected, cultivation, identification, classification of the type of Mycoplasma, and drug sensitivity test in vitro must be of the first priority so that antibiotics be selected reasonably.