CAJ | 학술논문

目的了解北京地区儿童A组链球菌(GAS)emm基因型别分布及药敏特征.方法采用PCR扩增联合测序对2014年5月至7月收集的北京地区16个区县36家医院儿童GAS菌株371株进行emm分型;采用VITEK-2全自动微生物分析系统及GPS-67药敏检测卡检测菌株对10种抗生素(青霉素、氨苄西林、红霉素、克林霉素、四环素、左氧氟沙星、替加环素、万古霉素、利奈唑胺和链阳霉素)的最小抑菌浓度(MIC),依据临床实验室标准化协会(CLSI) 2012年M100-S22判定标准判断其对相关抗菌药物敏感性,计算敏感率(S％)、中介率(I％)、耐药率(R％).结果共收集371株GAS,测定出5种emm基因型及15种亚型.emml型为主[54.7％(203/371株)],其次emm12型占44.2％(164/371株),其他型别占1.1％(4/371株).选取其中207株GAS进行药敏试验,结果对青霉素、氨苄西林、左氧氟沙星、替加环素、万古霉素、链阳霉素、利奈唑胺敏感率均为100.0％(207/207株);对克林霉素、红霉素和四环素耐药率分别为98.5％(204/207株)、98.1％(203/207株)和92.8％(192/207株);菌株对红霉素、克林霉素和四环素耐药率在不同地区、年龄和临床诊断间的分布差异无统计学意义(P＞0.05).结论北京地区2014年儿童GAS菌株emm基因型别分布较为集中,呈现以emml和emml2型为主,emml型稍高的分布特点.药敏检测结果显示对青霉素等β-内酰胺类和左氧氟沙星等喹诺酮类药物具有较高敏感性.对克林霉素和红霉素等大环内酯类抗菌药物的耐药水平较高,提示临床应合理选择用药.
목적 료해북경지구인동A조련구균(GAS)emm기인형별분포급약민특정.방법 채용PCR확증연합측서대2014년5월지7월수집적북경지구16개구현36가의원인동GAS균주371주진행emm분형;채용VITEK-2전자동미생물분석계통급GPS-67약민검측잡검측균주대10충항생소(청매소、안변서림、홍매소、극림매소、사배소、좌양불사성、체가배소、만고매소、리내서알화련양매소)적최소억균농도(MIC),의거림상실험실표준화협회(CLSI) 2012년M100-S22판정표준판단기대상관항균약물민감성,계산민감솔(S％)、중개솔(I％)、내약솔(R％).결과 공수집371주GAS,측정출5충emm기인형급15충아형.emml형위주[54.7％(203/371주)],기차emm12형점44.2％(164/371주),기타형별점1.1％(4/371주).선취기중207주GAS진행약민시험,결과대청매소、안변서림、좌양불사성、체가배소、만고매소、련양매소、리내서알민감솔균위100.0％(207/207주);대극림매소、홍매소화사배소내약솔분별위98.5％(204/207주)、98.1％(203/207주)화92.8％(192/207주);균주대홍매소、극림매소화사배소내약솔재불동지구、년령화림상진단간적분포차이무통계학의의(P＞0.05).결론 북경지구2014년인동GAS균주emm기인형별분포교위집중,정현이emml화emml2형위주,emml형초고적분포특점.약민검측결과현시대청매소등β-내선알류화좌양불사성등규낙동류약물구유교고민감성.대극림매소화홍매소등대배내지류항균약물적내약수평교고,제시림상응합리선택용약.
Objective To investigate the distribution of the emm types and antimicrobial susceptibility to group A streptococcus (GAS) in Beijing.Methods A total of 371 strains of GAS were isolated from the oropharyngeal swabs which were collected from 36 hospitals in Beijing from May to July in 2014.The emm types were performed by PCR and sequencing.The minimum inhibitory concentrations (MIC) in 10 kinds of antibiotics (Penicillin,Ampicillin, Erythromycin, Clinamycin, Tetracycline, Levofloxacin, Tigecycline, Vancomycin, Linezolid and Streptogramin) were detected by VITEK-2 compact with GPS-67 test kit.Antimicrobial susceptibility was evaluated based on M100-S22 criteria and susceptible rate, intermediary rate, and drug resistance rate was analyzed.Results Five emm types and 15 subtypes were identified, and emml type was 54.7 ％ (203/371 strains), emm 12 type was 44.2％ (164/371 strains) and other emm types were 1.1％ (4/37 strains).And 207 strains of GAS were selected for antimicrobial susceptibility test.All of 207 isolates were sensitive to Penicillin, Ampicillin, Levofloxacin, Tigecycline, Vancomycin, Linezolid and Streptogramin.The percentages of the strains that were of resistance to Clindamycin, Erythromycin and Tetracycline were 98.5％ (204/207 strains), 98.1％ (203/207 strains) and 92.8％ (192/207 strains), respectively.There were no statistically significant difference in the rates of the strains that were resistant to Erythromycin, Lindamycin and Tetracycline among different districts, ages and clinical diagnosis (P ＞ 0.05).Conclusions The emm types of all strains were distributed intensively in Beijing in 2014, and emml, emml2 constituted the main types.The strains of GAS are sensitive to β-lactams and quinolones antibiotics and highly resistant to the macrolide antibiotics and resistant higher to Clindamycin and Erythromycin,which suggests a reasonably use of antibiotics in hospitals nowadays.