Kim Hyo Youl, Uh Young
Department of Infectious Disease, Yonsei University Wonju College of Medicine, 162 Ilsan-dong, Wonju, Kangwon-do 220-701, Korea.
Yonsei Med J. 2004 Aug 31;45(4):591-7. doi: 10.3349/ymj.2004.45.4.591.
This study evaluated the antimicrobial susceptibilities and macrolide resistance mechanisms of beta-hemolytic streptococci (BHS), and an additional objective was to assess the effects of 'the separation of prescribing and dispensing (SPD) of medications' on bacterial resistance rate and distribution of phenotypes and genotypes of erythromycin-resistant BHS by comparing the antimicrobial susceptibility data before (1990- 2000) and after the implementation of SPD at one tertiary care hospital in South Korea. Between the period of January 2001 and December 2002, the minimal inhibitory concentrations of six antimicrobials were determined for 249 clinical isolates of BHS. Resistance mechanisms of erythromycin-resistant (intermediate and resistant) isolates were studied by using the double disk test and PCR. Overall, the resistance rates to tetracycline, erythromycin, and clindamycin were 75.5%, 32.9%, and 32.5%, respectively. Sixty-seven (81.7%) of 82 erythromycin- resistant isolates expressed constitutive resistance to macrolide- lincosamide-streptogramin B antibiotics (a constitutive MLSB phenotype); 11 isolates (13.4%) expressed an M phenotype; and four isolates (4.9%) had an inducible MLSB resistance phenotype. erm(A) was found in isolates with constitutive/ inducible MLSB phenotypes, erm(B) with the constitutive/ inducible MLSB phenotype, and mef(A) with the M phenotype. We found that resistance rates to erythromycin and clindamycin among S. agalactiae, S. pyogenes, and group C streptococci isolates were still high after the implementation of the SPD policy in Korea, and that the constitutive MLSB resistance phenotype was dominant among erythromycin- resistant BHS in this Korean hospital.
本研究评估了β溶血性链球菌（BHS）的抗菌药敏性及大环内酯类耐药机制，另一个目标是通过比较韩国一家三级护理医院在实施药品处方与调配分离（SPD）之前（1990 - 2000年）和之后的抗菌药敏数据，来评估“药品处方与调配分离（SPD）”对耐红霉素BHS的细菌耐药率以及表型和基因型分布的影响。在2001年1月至2002年12月期间，测定了249株BHS临床分离株对六种抗菌药物的最低抑菌浓度。采用双纸片试验和聚合酶链反应（PCR）研究了耐红霉素（中介和耐药）分离株的耐药机制。总体而言，对四环素、红霉素和克林霉素的耐药率分别为75.5%、32.9%和32.5%。82株耐红霉素分离株中有67株（81.7%）对大环内酯 - 林可酰胺 - 链阳菌素B类抗生素表现出组成型耐药（组成型MLSB表型）；11株分离株（13.4%）表现为M表型；4株分离株（4.9%）具有诱导型MLSB耐药表型。在具有组成型/诱导型MLSB表型的分离株中发现了erm(A)，在具有组成型/诱导型MLSB表型的分离株中发现了erm(B)，在具有M表型的分离株中发现了mef(A)。我们发现，在韩国实施SPD政策后，无乳链球菌、化脓性链球菌和C组链球菌分离株对红霉素和克林霉素的耐药率仍然很高，并且在这家韩国医院中，组成型MLSB耐药表型在耐红霉素BHS中占主导地位。
