【摘要】 目的:了解红霉素耐药的葡萄球菌对克林霉素的耐药表型和基因型,指导临床合理使用抗生素。方法:收集本院2005年1月至2006年6月对红霉素耐药、克林霉素敏感和中介的葡萄球菌178株(其中金黄色葡萄球菌62株,凝固酶阴性葡萄球菌(CNS)116株),用美国临床实验室标准委员会推荐的纸片法测其耐药表型,通过PCR测其耐药基因,并进行对比。结果:178株葡萄球菌中红霉素耐药、克林霉素敏感且D试验阳性(iLSM)37株(20.8%),红霉素耐药、克林霉素敏感D试验阴性(MS)46株(25.8%),红霉素、克林霉素均耐药(cLSM)95株(53.4%)。PCR检测显示所有菌株中3种基因(ermA、ermC、mrsA)至少一种为阳性。MS葡萄球菌中仅检测到mr-sA基因,其他均检测到ermA、ermC基因。在所测的金黄色葡萄球菌中iLSM型以检测出ermA多于ermC;cMLS中未检出ermC基因;而在CNS中iLSM、cLSM2型均以检测到ermC居多。结论:临床上分离的对红霉素耐药、克林霉素敏感的葡萄球菌诱导性耐药比较常见,耐药表型D试验与多重PCR检测结果相一致,且前者方法简单易行,建议实验室应加强对葡萄球菌D试验的常规检测,以指导临床正确合理使用大环内酯类、林可酰胺类抗生素。更多还原

【Abstract】 Aim:To explore the phenotypes and genotypes of staphylococcus spp.resistant to clindamycin induced by erythromycin for rational prescription of antibiotics.Methods:A total of 178 strains of staphylococcus resistant to erythromycin,meanwhile susceptible or intermediate to clindamycin,were collected from January,2005 to June,2006.Their resistant phenotypes were assayed by D test of NCCLS,and genotypes were compared by PCR respectively.Results: Of 178 strains,37(20.8%) were resistant to erythromycin and susceptible to clindamycin,showed with positive D test(iLSM);46(25.8%) were resistant to erythromycin and susceptible to clindamycin but showed negative D test(MS);95(53.4%) were resistant to clindamycin and erythromycin(cLSM).At least 1 gene out of 3 genes(ermA,ermC and mrsA) were assayed positive in all these strains by multiplex PCR.Only mrsA gene was found in the strains of negative D test(MS),the ermA and ermC genes were found in other strains;the ermA gene were more often detected than ermC gene in those with iLSM phenotype;whereas ermC gene was not found in those with cMLS phenotype;ermC gene was dominant in those with iLSM and cLSM phenotype.Conclusion: The strains resistant to erythromycin and susceptible to clindamycin(iLSM) are common in the staphylococcus isolated from clinic.The D test results of resistant phenotype is consistent with those of multiple PCR,and the former is more simple.The D test should be conducted routinely in laboratory for rational prescription of macrolides and lincomycin.更多还原