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目的了解武汉地区儿童肺炎链球菌携带率、耐药性、耐药基因及血清型流行状况。方法采集鼻咽拭子,以琼脂稀释法测定肺炎链球菌对12种抗菌药物的最低抑菌浓度,聚合酶链式反应检测红霉素耐药基因,荚膜肿胀试验进行血清学分型。结果武汉地区儿童肺炎链球菌携带率为22.31%(135/605)。存活的133株细菌中,青霉素不敏感肺炎链球菌(PNSSP)发生率为45.9%(61/133);头孢菌素第一代(头孢氨苄)、二代(头孢克洛)、三代(头孢克肟、头孢泊肟、头孢曲松)敏感率依次为6.O%、45.1%、54.9%、56.4%、88.7%;除1株环丙沙星低耐株外,未发现氟喹诺酮类耐药株。大环内酯类敏感率仅为14.3%～15.8%。在114株红霉素耐药株中,检出 ermB 基因76株(66.7%),2株(1.8%)低耐株含有 mefA 基因,46株(40.4%)同时具有 ermB 和 mefA 基因。血清分型涉及17个血清群,主要分布在19、23、6、15和14血清群,7株细菌未能分群。PNSSP 分布在19、23、6和未分型血清群。结论武汉地区肺炎链球菌耐药严重,红霉素耐药主要为核糖体修饰(ermB 介导)引起,流行血清群以19、23、6为主。
Objective To understand the prevalence of pneumococcal carriage, drug resistance, drug resistance genes and seropositive prevalence in children in Wuhan. Methods Nasopharyngeal swabs were collected, the minimum inhibitory concentration of Streptococcus pneumoniae against 12 antibiotics was determined by agar dilution method, the erythromycin resistance gene was detected by polymerase chain reaction (PCR) and the capsular swelling test was performed for serological typing. Results The prevalence of Streptococcus pneumoniae in children in Wuhan was 22.31% (135/605). Among the 133 bacteria that survived, the incidence of penicillin-insensitive pneumococcal (PNSSP) was 45.9% (61/133); the first generation of cephalosporins (cephalexin), the second generation (cefaclor), the third generation Oxime, cefpodoxime and ceftriaxone) were 6.O%, 45.1%, 54.9%, 56.4% and 88.7%, respectively. No fluoroquinolone resistance was found except for one low resistant strain of ciprofloxacin Strain. Macrolide susceptibility was only 14.3% ~ 15.8%. Among 114 erythromycin - resistant strains, 76 (66.7%) were detected in ermB gene, 2 (1.8%) low resistant plants contained mefA gene and 46 (40.4%) had both ermB and mefA genes. Serotypes involved 17 serogroups, mainly in 19, 23, 6, 15 and 14 serogroups, and 7 strains failed to segregate. PNSSP is distributed in 19, 23, 6 and undifferentiated serogroups. Conclusion Streptococcus pneumoniae was highly resistant in Wuhan and erythromycin resistance was mainly caused by ribosome modification (ermB-mediated). The epidemic serogroups were mainly composed of 19, 23 and 6.