CAJ | 학술논문

目的：探讨南京地区肺炎链球菌临床分离株对β-内酰胺类抗生素的耐药性及耐药机制，了解其主要突变类型及耐药传播方式。方法2010-2012年，从南京地区7家大医院共收集了130株肺炎链球菌临床分离株，检测其对14种常见抗生素的敏感性，对β-内酰胺类高耐株中耐药相关基因 pbp1A、pbp2B、pbp2X 进行扩增，用限制性内切酶长度多态性分析（RFLP）方法进行分子生物学分型，了解其传播方式。结果南京地区肺炎链球菌青霉素不敏感率为74．6％，其中23．1％中介，51．5％耐药。头孢呋辛、头孢噻肟、头孢吡肟、头孢曲松、阿莫西林、美罗培南的耐药率分别为69．2％、17．7％、12．3％、3．1％、6．2％、16．9％，儿童耐药率较成人高。青霉素与其他β-内酰胺类抗生素的最低抑菌浓度（MIC）水平呈正相关。有5株分子分型为 A1-B1-X1型的多药耐药株可能为克隆传播。结论南京地区儿童分离株对青霉素的耐药率偏高，且伴有其他β-内酰胺类抗生素的交叉耐药，分子分型结果显示存在小范围的阿莫西林耐药株的克隆传播。
목적：탐토남경지구폐염련구균림상분리주대β-내선알류항생소적내약성급내약궤제，료해기주요돌변류형급내약전파방식。방법2010-2012년，종남경지구7가대의원공수집료130주폐염련구균림상분리주，검측기대14충상견항생소적민감성，대β-내선알류고내주중내약상관기인 pbp1A、pbp2B、pbp2X 진행확증，용한제성내절매장도다태성분석（RFLP）방법진행분자생물학분형，료해기전파방식。결과남경지구폐염련구균청매소불민감솔위74．6％，기중23．1％중개，51．5％내약。두포부신、두포새우、두포필우、두포곡송、아막서림、미라배남적내약솔분별위69．2％、17．7％、12．3％、3．1％、6．2％、16．9％，인동내약솔교성인고。청매소여기타β-내선알류항생소적최저억균농도（MIC）수평정정상관。유5주분자분형위 A1-B1-X1형적다약내약주가능위극륭전파。결론남경지구인동분리주대청매소적내약솔편고，차반유기타β-내선알류항생소적교차내약，분자분형결과현시존재소범위적아막서림내약주적극륭전파。
Objective To explore the prevalence,mechanism and dissemination of β-lactam resistant streptococcus pneumoniae isolates in Nanjing area.Methods A collection of 130 strains of streptococcus pneumoniae isolated from seven teaching hospitals in Nanjing between 2010 and 2012 were included in this study.MICs of 14 common antibiotics were determined by agar dilution test. pbp1A、pbp2B、pbp2X genes were amplified.All the isolates were analyzed by pbp fingertyping to e-valuate their gene relateness. Results The resistance rates of clinical isolates to penicillin, cefuroxime ,cefotaxime ,cefepime ,ceftiaxone ,amoxicillin and meropenem were 5 1 .5 % ,6 9 .2 % , 17.7%,12.3%,3.1%,6.2%,16.9% respectively.The penicillin resistant rate in children was higher than that in adult.A good correlation had been found between penicillin and cefuroxime, cefepime,amoxicillin.5 isolates exhibited type A1-B1-X1 in molecular typing might be the same clone.Conclusion The penicillin resistant rate in children is high,a small range of clone dissemina-tion is found in Nanjing.