García Susana, Casco Ricardo, Perazzi Beatriz, De Mier Carmen, Vay Carlos, Famiglietti Angela
Laboratorio de Bacteriología Clínica, Departamento de Bioquímica Clínica, Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires.
Medicina (B Aires). 2008;68(5):358-62.
The first isolates of Neisseria gonorrhoeae resistant to fluoroquinolones in Argentina were reported in 2000. Since January 2005 to June 2007 Neisseria gonorrhoeae was studied in 595 men who have sex with men (MSM) and 571 heterosexual men. The gonorrhea prevalence in MSM and heterosexual men was 0.091(91/1000) and the Neisseria gonorrhoeae ciprofloxacin resistant (CRNG) was 20% in MSM and 3.8% in heterosexual men (p: 0.0416). Thirteen out of 106 isolates from 11 MSM and 2 heterosexual men were CRNG. Six out of eleven MSM had urethritis, one also carried Neisseria gonorrhoeae in rectum and 5 patients were asymptomatic carriers (rectum 2, pharynx 2, urethra 1). No epidemiological relation was found among the patients. Two heterosexual men had urethritis. The 8 symptomatic men were treated with ciprofloxacin but treatment failed in all of them. These patients and the asymptomatic ones were treated with ceftriaxone, 500 mg IM. The post treatment microbiological controls were negative. The CRNG isolates had ciprofloxacin MIC between 2 and 32 (microg/ml), all were negative to penicillinase, 4 out of 13 were chromosomally resistant to penicillin (MIC: 1 microg/ml). The MICs (microg/ml) ranges for several antimicrobial agents were: penicillin: 0.016-1; tetracycline: 0.125-2; ceftriaxone: 0.004-0.008; erythromycin: 0.032-2; azithromycin: 0.032-0.5; spectinomycin: 8-32. Due to the high level of ciprofloxacin-resistant N. gonorrhoeae isolated from MSM in our hospital, another antimicrobial agent for empirical therapy should be used in these patients.
2000年，阿根廷首次报告了对氟喹诺酮类耐药的淋病奈瑟菌分离株。2005年1月至2007年6月，对595名男男性行为者（MSM）和571名异性恋男性的淋病奈瑟菌进行了研究。MSM和异性恋男性的淋病患病率分别为0.091（91/1000），MSM中淋病奈瑟菌对环丙沙星耐药（CRNG）率为20%，异性恋男性为3.8%（p：0.0416）。从11名MSM和2名异性恋男性分离的106株菌株中有13株为CRNG。11名MSM中有6名患有尿道炎，1名直肠也携带淋病奈瑟菌，5名患者为无症状携带者（直肠2例、咽部2例、尿道1例）。患者之间未发现流行病学关联。2名异性恋男性患有尿道炎。8名有症状的男性接受了环丙沙星治疗，但全部治疗失败。这些患者和无症状患者接受了头孢曲松500mg肌内注射治疗。治疗后微生物学检查为阴性。CRNG分离株的环丙沙星MIC在2至32（μg/ml）之间，所有菌株对青霉素酶均为阴性，13株中有4株对青霉素染色体耐药（MIC：1μg/ml）。几种抗菌药物的MIC（μg/ml）范围为：青霉素：0.016 - 1；四环素：0.125 - 2；头孢曲松：0.004 - 0.008；红霉素：0.032 - 2；阿奇霉素：0.032 - 0.5；壮观霉素：8 - 32。由于我院从MSM中分离出的淋病奈瑟菌对环丙沙星耐药水平较高，这些患者应使用另一种抗菌药物进行经验性治疗。
