CAJ | 학술논문

目的：了解新疆阿拉尔地区耐红霉素葡萄球菌中克林霉素诱导耐药的情况,以指导临床正确选择抗菌药物,避免误诊误治。方法对临床分离并鉴定的300株葡萄球菌采用K-B纸片琼脂扩散法检测葡萄球菌对红霉素和克林霉素的耐药性,再采用D试验检测耐红霉素葡萄球菌对克林霉素诱导的耐药性。结果本组300份送检标本中检出凝固酶阴性葡萄球菌175株(58.3%),金黄色葡萄球菌125株(41.7%)。①葡萄球菌对克林霉素的敏感率为38.0%(114/300),对红霉素的敏感率为19.7%(59/300),对克林霉素耐药的菌株同时也对红霉素耐药。②对红霉素和克林霉素均耐药的比例金黄色葡萄球菌为69.6%(87/125)高于凝固酶阴性葡萄球菌的56.6%(99/175),差异有统计学意义(P=0.031)。③耐甲氧西林金黄色葡萄球菌(methicillin resistant staphylococcus aureus, MRSA)对克林霉素敏感的比例为21.6%(21/97)明显低于耐甲氧西林凝固酶阴性葡萄球菌( methicillin-resistant coagulase negative staphylococci, MRCNS)的40.9%(63/154),差异有统计学意义(P=0.002)。④55株对红霉素耐药而对克林霉素敏感的葡萄球菌D试验阳性39株(70.9%),其中MRSA可诱导克林霉素耐药发生率为85.7%(18/21),MRCNS可诱导克林霉素耐药发生率为76.2%(16/21),差异无统计学意义(P=0．452)；合并甲氧西林耐药的两类葡萄球菌诱导克林霉素耐药发生率均高于相应的敏感菌株,差异均有统计学意义(P均<0.05)。结论新疆阿拉尔地区红霉素和克林霉素对不同类别葡萄球菌耐药情况存在差异,有近2/3的葡萄球菌存在红霉素诱导克林霉素耐药情况,进行D试验检测可避免常规药物敏感试验中克林霉素假性敏感。
목적：료해신강아랍이지구내홍매소포도구균중극림매소유도내약적정황,이지도림상정학선택항균약물,피면오진오치。방법대림상분리병감정적300주포도구균채용K-B지편경지확산법검측포도구균대홍매소화극림매소적내약성,재채용D시험검측내홍매소포도구균대극림매소유도적내약성。결과본조300빈송검표본중검출응고매음성포도구균175주(58.3%),금황색포도구균125주(41.7%)。①포도구균대극림매소적민감솔위38.0%(114/300),대홍매소적민감솔위19.7%(59/300),대극림매소내약적균주동시야대홍매소내약。②대홍매소화극림매소균내약적비례금황색포도구균위69.6%(87/125)고우응고매음성포도구균적56.6%(99/175),차이유통계학의의(P=0.031)。③내갑양서림금황색포도구균(methicillin resistant staphylococcus aureus, MRSA)대극림매소민감적비례위21.6%(21/97)명현저우내갑양서림응고매음성포도구균( methicillin-resistant coagulase negative staphylococci, MRCNS)적40.9%(63/154),차이유통계학의의(P=0.002)。④55주대홍매소내약이대극림매소민감적포도구균D시험양성39주(70.9%),기중MRSA가유도극림매소내약발생솔위85.7%(18/21),MRCNS가유도극림매소내약발생솔위76.2%(16/21),차이무통계학의의(P=0．452)；합병갑양서림내약적량류포도구균유도극림매소내약발생솔균고우상응적민감균주,차이균유통계학의의(P균<0.05)。결론신강아랍이지구홍매소화극림매소대불동유별포도구균내약정황존재차이,유근2/3적포도구균존재홍매소유도극림매소내약정황,진행D시험검측가피면상규약물민감시험중극림매소가성민감。
Objective To understand the antibiotic resistance of Staphylococcus to clindamycin induced by erythro-mycin in the Alar sub-region of the Xinjiang Uygur autonomous region, and to guide the clinical selection of antibacterial drugs to avoid misdiagnosis. Methods Drug resistance of clinically isolated and identified 300 strains of Staphylococcus was detec-ted using K-B agar diffusion method, and then the D test method was used for detection of inducible clindamycin resistance in the erythromycin resistant Staphylococcus. Results ①The Staphylococcus sensitive to clindamycin was 38. 0% (114/300) and to erythromycin was 19. 7% (59/300), and clindamycin resistant strains were also resistant to erythromycin. ②The pro-portion of erythromycin and clindamycin resistant Staphylococcus aureus (69. 6%) was higher than that of coagulase negative staphylococcus (56. 6%), and the difference was significant (P=0. 031). ③The sensitive proportion of methicillin-resistant Staphylococcus aureus (MRSA) on clindamycin (21. 6%, 21/97) was significantly lower than that of methicillin resistant co-agulase negative staphylococcus (MRCNS;40. 9%, 63/154) with the significant difference (P=0. 002). ④Among the 55 Staphylococcus strains of erythromycin resistant and clindamycin sensitive, 39 strains were positive in D test (70. 9%, 39/55), while MRSA inducible clindamycin resistance rate was 85. 7% (18/21) and NRCNS was 76. 2% (16/21), and the difference was no significant (P=0. 452) induction clindamycin resistance rate of the two types of methicillin resistant Staphy-lococcus were also higher than that of sensitive strains correspondingly, with significant difference (all P<0. 05). Conclu-sion The antibiotic resistance for erythromycin and clindamycin in Alar area is different from different categories of Staphylo-coccus aureus, and nearly 2/3 of Staphylococcus strains have clindamycin resistance induced by erythromycin. D test can de-tect the pseudo-sensitivity of clindamycin in routine drug susceptibility test.