学龄前儿童肺炎链球菌耐药性及大环内酯类耐药基因分析

赖剑秀; 宋相泉; 徐菊芳; 戴玉柱; 段达荣

doi:10.13898/j.cnki.issn.1000-2200.2023.11.022

学龄前儿童肺炎链球菌耐药性及大环内酯类耐药基因分析

Analysis of drug-resistance and macrolide-resistant genes of Streptococcus pneumoniae in preschool children

摘要

摘要:
目的了解学龄前儿童肺炎链球菌（Streptococcus pneumoniae，Sp）的耐药性及大环内酯类耐药基因分布。
方法选取60株Sp，采用E-test法检测菌株对青霉素、阿莫西林、头孢噻肟、头孢曲松的最低抑菌浓度；纸片扩散法检测Sp对红霉素、克林霉素、复方新诺明、四环素、氯霉素、左氧氟沙星、万古霉素、利奈唑胺的药物敏感性；PCR检测大环内酯类耐药基因ermB、mefA和mefE的检出率。患儿按年龄分为0~12个月组、13~36个月组和37~60个月组，比较各组抗菌药物不敏感率和耐药基因检出率。
结果药敏试验结果显示，60株Sp对红霉素、四环素和复方新诺明的耐药率较高，分别为95.00%，93.30%，61.07%；Sp对万古霉素、厄他培南、利耐唑胺和泰利霉素均敏感，敏感率为100.00%。0~12个月组儿童对头孢噻肟、头孢曲松、青霉素G、阿莫西林、红霉素、美洛培南不敏感率均高于13~36个月组和37~60个月组，其中3组头孢噻肟、头孢曲松不敏感率差异有统计学意义（P < 0.05），36~60个月组儿童对复方新诺明、氧氟沙星、四环素不敏感率最高。PCR结果显示，大环内酯类耐药基因ermB检出率最高（98.33%），mefA和ermB+mefA测出率均为78.33%，mefE和ermB+mefE检出率均为60.00%，ermB+mefA+mefE检出率最低（46.67%）。mefE和ermB+mefE在0~12个月组、13~36个月组、37~60个月组检出率逐渐降低（P < 0.05）。
结论学龄前儿童Sp对大环内酯类耐药率较高，ermB耐药基因为Sp对大环内酯类抗生素耐药的主要基因型。

Abstract:
ObjectiveTo understand the drug resistance of Streptococcus pneumoniae (Sp) and the distribution of macrolide-resistant genes in preschool children.
MethodsSixty Sp strains were selected, and the minimum inhibitory concentrations of penicillin, amoxicillin, cefotaxime and ceftriaxone were detected by E-test method; the susceptibility of Sp to erythromycin, clindamycin, cotrimoxazole, tetracycline, chloramphenicol, levofloxacin, vancomycin and linezolid was detected by disk diffusion method; the detection rate of macrolide-resistant genes ermB, mefA and mefE was determined by PCR.The children were divided into 0 to 12-month group, 13 to 36 month group and 37 to 60-month group according to their age.The antimicrobial insensitivity rate and the detection rate of drug resistance genes in the three groups were compared.
ResultsThe results of drug sensitivity test displayed that the 60 strains of Sp showed high drug resistance rate to erythromycin, tetracycline and cotrimoxazole, and the resistance rates were 95.0%, 93.3% and 61.7%, respectively; Sp was sensitive to vancomycin, ertapenem, linezolid and telithromycin, and the sensitivity rate was 100.0%.The insensitivity rates of children to cefotaxime, ceftriaxone, penicillin G, amoxicillin, erythromycin and meropenem in the 0 to 12-month group were higher than those in the 12 to 36-month group and 36 to 60-month group, the difference of insensitivity rates of cefotaxime, ceftriaxone among the three groups was statistically significant (P < 0.05), and the insensitivity rates of children to cotrimoxazole, ofloxacin and tetracycline in the 36 to 60-month group were the highest.The PCR results showed that the detection rate of macrolide-resistant gene ermB was the highest (98.33%), which was 78.33% for mefA and ermB+mefA, 60.00% for mefE and ermB+mefE, and 46.67% for ermB+mefA+mefE.The detection rates of mefE and ermB+mefE gradually decreased in the 0 to 12-month group, 13 to 36-month group and 37 to 60-month group (P < 0.05).
ConclusionsThe resistance rate of Sp to macrolide in preschool children is high, and the resistance gene ermB is the main genotype of Sp to macrolide.

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