肺炎链球菌对红霉素的耐药表型及耐药基因

The phenotype and genotype patterns of erythromycin-resistant Streptococcus pneumoniae

目的 研究肺炎链球菌对红霉素的耐药表型及耐药基因。方法 根据美国临床实验室标准化委员会标准使用微量肉汤稀释法 ,检测 192株肺炎链球菌对红霉素、克林霉素、青霉素、喹诺酮类抗菌药物的最低抑菌浓度 (MIC)。应用红霉素、克林霉素、螺旋霉素纸片行三纸片扩散法 ,检测 14 8株红霉素耐药肺炎链球菌的耐药表型。应用PCR检测 14 8株红霉素耐药肺炎链球菌携带的耐药基因。结果 肺炎链球菌对青霉素的耐药率 (中介率 +耐药率 )为 4 2 7% ,对红霉素、克林霉素的耐药率分别为 77 6 %、6 6 7%。 14 8株红霉素耐药株中 ,耐药基因以ermB基因 (79 1% )为主 ,耐药表型以内在型耐药 (cMLS) (85 1% )为主。携带ermB基因的肺炎链球菌 ,74 4 %的菌株对红霉素的MIC值 >16 0 μg/ml;而携带mefA基因的肺炎链球菌对红霉素的MIC值在 0 5～ 4 0 μg/ml之间。 结论肺炎链球菌对红霉素的耐药率较高 ;耐药表型以cMLS为主 ,耐药基因以ermB介导的靶位改变多见。

Objective To investigate the resistance phenotypes and genotypes in erythromycin-resistant Streptococcus (S.) pneumoniae . Methods The minimum inhibitory concentration (MIC) of erythromycin,clindamycin,penicillin and fluoroquinolones against 192 strains of S.pneumoniae was tested with broth microdilution method according to the guidelines of the National Committee for Clinical Laboratory Standards. Of 148 clinical isolates of erythromycin resisitant S.pneumoniae ,the macrolide resistance phenotypes were observed by the erythromycin-clindamycin-spiramycin triple-disc test and erythromycin resistance genes were detected by polymerase chain reaction.Results 42.7% S.pneumoniae isolates was resistant(intermediate and resistant) to penicillin while the resistance rates to erythromycin and clindamycin were 77.6% and 66.7% respectively. The ermB gene,being the most prevalent,was detected in 79.1% of the 148 erythromycin-resistant strains.The main phenotype (85.1%) of erythromycin-resistant strains was constitutive macrolide,lincosamide,and streptogramin B resistance phenotype (cMLS). Erythromycin MICs for S.pneumoniae ermB-positive isolates were higher than those for mefA-positive isolates. 74.4% of the ermB-positive isolates demonstrated erythromycin MICs of >16.0 μg/ml,and the erythromycin MICs for mefA-positive isolates ranged from 0.5～4.0 μg/ml.Conclusions The resistance rate of S.pneumoniae to erythromycin is high in China. The main phenotype is cMLS. Ribosomal modification (ermB gene coded) is the main resistance mechanism against erythromycin in S.pneumoniae .