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[葡萄球菌临床菌株中大环内酯-林可酰胺-链阳菌素B(MLS(B))及泰利霉素耐药性的研究]

[Investigation of macrolide-lincosamide-streptogramin B (MLS(B)) and telithromycin resistance in clinical strains of staphylococci].

作者信息

Saribaş Zeynep, Tunçkanat Ferda, Ozçakir Olcay, Ercis Serpil

机构信息

Hacettepe Universitesi Tip Fakültesi, Tibbi Mikrobiyoloji Anabilim Dali, Ankara.

出版信息

Mikrobiyol Bul. 2010 Apr;44(2):177-86.

Abstract

The aim of this study was to determine the prevalence of macrolide-lincosamide-streptogramin B (MLS(B)) resistance and also to search for telithromycin resistance in staphylococcus strains isolated at Hacettepe University Hospital, Ankara, Turkey. A total of 381 Staphylococcus aureus isolates and 94 coagulase-negative staphylococci (CNS) were tested by disc approximation method. Methicillin resistance of these isolates was searched by disc diffusion test using 30 microg cefoxitin discs. Distribution of erm genes was detected by PCR method. Of 381 isolates 112 (29.4%) S. aureus and 58 (61.7%) CNS were found to be resistant to erythromycin. Among these, the inducible MLS(B) (iMLS(B)) resistance was the most prevalent pattern, being 56.2% and 41.4% among S. aureus and CNS isolates, respectively. The frequency of constitutive MLS(B) resistance (cMLS(B)) was 40.2% for S. aureus and 34.5% for CNS. Macrolide-streptogramin B (MS(B)) resistance pattern was detected only in CNS isolates (24.1%). In 4 (3.6%) of S. aureus isolates mixed pattern demonstrating both inducible and constitutive patterns was detected. None of the isolates susceptible to erythromycin showed resistance to telithromycin. As a remarkable finding of this study D-shaped inhibition zones around the telithromycin discs was observed in all of the isolates with iMLS(B) and macrolide-streptogramin B (MS(B)) resistance phenotypes. The isolates showing cMLS(B) pattern were also resistant to telithromycin (no zone of inhibition around the telithromycin discs). A total of 170 erythromycin resistant staphylococcal isolates were tested for the presence of erm and msrA genes. Among the S. aureus isolates with iMLS(B) and cMLS(B) phenoypes, the most common findings were the detection of ermA (44/63) and ermA + ermC (35/45) genes, respectively. All of the four isolates with mixed phenotype harboured ermA gene. With respect to CNS isolates, the most frequently detected gene was ermC (37/58); whereas iMLS(B) and cMLS(B) resistant CNS isolates had ermC (11/24) and ermA + ermC (10/20) as the most prevalent resistance genes, respectively. msrA gene was detected in 11 of 14 CNS isolates with MS(B) resistance. Two of these were also carrying ermA while 3 isolates harboured ermCalong with msrA gene. The results of this study showed that inducible MLS(B) resistance was the most prevalent phenotype among the clinical staphylococcal isolates in our hospital. All of these isolates also demonstrated inducible resistance pattern against telithromycin, a new antibiotic suggested particularly for the treatment of infections with iMLS(B) resistant bacteria. The telithromycin resistance patterns need to be tested in other centers and the impact of this issue on the clinical use of telithromycin should be investigated.

摘要

本研究的目的是确定土耳其安卡拉哈杰泰佩大学医院分离的葡萄球菌菌株中大环内酯-林可酰胺-链阳菌素B(MLS(B))耐药性的流行情况,并寻找泰利霉素耐药性。采用纸片扩散法对381株金黄色葡萄球菌分离株和94株凝固酶阴性葡萄球菌(CNS)进行了检测。使用30μg头孢西丁纸片通过纸片扩散试验检测这些分离株的耐甲氧西林情况。通过PCR方法检测erm基因的分布。在381株分离株中,发现112株(29.4%)金黄色葡萄球菌和58株(61.7%)CNS对红霉素耐药。其中,诱导型MLS(B)(iMLS(B))耐药是最常见的模式,在金黄色葡萄球菌和CNS分离株中分别为56.2%和41.4%。组成型MLS(B)(cMLS(B))耐药的频率在金黄色葡萄球菌中为40.2%,在CNS中为34.5%。大环内酯-链阳菌素B(MS(B))耐药模式仅在CNS分离株中检测到(24.1%)。在4株(3.6%)金黄色葡萄球菌分离株中检测到同时具有诱导型和组成型模式的混合模式。所有对红霉素敏感的分离株均未显示对泰利霉素耐药。作为本研究的一个显著发现,在所有具有iMLS(B)和大环内酯-链阳菌素B(MS(B))耐药表型的分离株中,观察到泰利霉素纸片周围呈D形抑菌圈。显示cMLS(B)模式的分离株也对泰利霉素耐药(泰利霉素纸片周围无抑菌圈)。对总共170株耐红霉素葡萄球菌分离株检测了erm和msrA基因的存在情况。在具有iMLS(B)和cMLS(B)表型的金黄色葡萄球菌分离株中,最常见的发现分别是检测到ermA(44/63)和ermA + ermC(35/45)基因。所有4株具有混合表型的分离株均携带ermA基因。对于CNS分离株,最常检测到的基因是ermC(37/58);而具有iMLS(B)和cMLS(B)耐药的CNS分离株中,最常见的耐药基因分别是ermC(11/24)和ermA + ermC(10/20)。在14株具有MS(B)耐药的CNS分离株中,11株检测到msrA基因。其中2株还携带ermA,3株同时携带ermC和msrA基因。本研究结果表明,诱导型MLS(B)耐药是我院临床葡萄球菌分离株中最常见的表型。所有这些分离株对泰利霉素也表现出诱导耐药模式,泰利霉素是一种特别推荐用于治疗iMLS(B)耐药菌感染的新型抗生素。需要在其他中心检测泰利霉素的耐药模式,并应研究此问题对泰利霉素临床应用产生的影响。

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