Dubey Debasmita, Rath Shakti, Sahu Mahesh C, Rout Subhrajita, Debata Nagen K, Padhy Rabindra N
Microbiology Department, IMS & Sum Hospital, Siksha 'O' Anusandhan University, Kalinga Nagar, Bhubaneswar 751003, Odisha, India.
Asian Pac J Trop Biomed. 2013 Feb;3(2):148-53. doi: 10.1016/S2221-1691(13)60040-4.
To investigate the infection of hospital- and community-acquired "erythromycin-induced clindamycin resistant" strains or D-test positives of clinical isolates of Staphylococcus aureus (S. aureus) (with and without methicillin resistance) in a hospital.
Strains of S. aureus isolated from clinical specimens were subjected to D-test and antibiotic profiling.
Of the total 278 isolates, 140 (50.35%) were D-test positives and the rest were D-test negatives. Further, of 140 (100%) positives, 87 (62.14%) and 53 (37.85%) strains were from males and females, respectively. Of 140 (100%) positives, 117 (83.57%) were methicillin resistant S. aureus and 23 (16.42%) were methicillin sensitive S. aureus; of 140 strains, 103 (73.57%) strains from persons with and 37 (26.42%) were without related infections; of 140 strains, 91 (65%) and 49 (35%) were from hospital- and community-acquired samples, respectively. In 140 strains, 118 (84.28%) with comorbidities and 22 (15.71%) without comorbidities cases were recorded; similarly, persons with prior antibiotic uses contributed 108 (77.14%) and without 32 (22.85%) positive strains. These binary data of surveillance were analyzed by a univariate analysis. It was evident that the prior antibiotic uses and comorbidities due to other ailments were the determinative factors in D-test positivity, corroborated by low P values, P=0.001 1 and 0.002 4, respectively. All isolates (278) were resistant to 17 antibiotics of nine groups, in varying degrees; the minimum of 28% resistance for vancomycin and the maximum of 97% resistance for gentamicin were recorded. Further, of 278 strains, only 42 (15.1%) strains were resistant constitutively to both antibiotics, erythromycin resistant and clindamycin resistant, while 45 (16.2%) strains were constitutively sensitive to both antibiotics (erythromycin sensitive and clindamycin sensitive). Further, of the rest 191 (68.7%) strains were with erythromycin resistant and clindamycin resistant, of which only 140 (50.35%) strains were D-test positives, while the rest 51 (18.34%) strains were D-test negatives.
In view of high prevalence of D-test positive S. aureus strains, and equally high prevalence of multidrug resistant strains both in community and hospital sectors, undertaking of D-test may be routinely conducted for suppurative infections.
调查某医院临床分离的金黄色葡萄球菌（有无耐甲氧西林）中“红霉素诱导克林霉素耐药”菌株或D试验阳性的医院获得性和社区获得性感染情况。
对从临床标本中分离出的金黄色葡萄球菌菌株进行D试验和抗生素谱分析。
在总共278株分离株中，140株（50.35%）为D试验阳性，其余为D试验阴性。此外，在140株（100%）阳性菌株中，男性菌株87株（62.14%），女性菌株53株（37.85%）。在140株（100%）阳性菌株中，耐甲氧西林金黄色葡萄球菌117株（83.57%），甲氧西林敏感金黄色葡萄球菌23株（16.42%）；在140株菌株中，有相关感染的患者菌株103株（73.57%），无相关感染的患者菌株37株（26.42%）；在140株菌株中，医院获得性样本91株（65%），社区获得性样本49株（35%）。在140株菌株中，有合并症的患者118株（84.28%），无合并症的患者有22株（15.71%）；同样，有既往抗生素使用史的患者贡献了108株（77.14%）阳性菌株，无既往抗生素使用史的患者有32株（22.85%）阳性菌株。这些监测的二元数据通过单因素分析进行分析。很明显，既往抗生素使用和其他疾病的合并症是D试验阳性的决定性因素，P值分别为0.001 1和0.002 4，证实了这一点。所有分离株（278株）对九组17种抗生素均有不同程度的耐药；万古霉素最低耐药率为28%，庆大霉素最高耐药率为97%。此外，在278株菌株中，仅42株（15.1%）菌株对红霉素和克林霉素均呈固有耐药，而45株（16.2%）菌株对红霉素和克林霉素均呈固有敏感。此外，其余191株（68.7%）菌株对红霉素耐药且对克林霉素耐药，其中仅140株（50.35%）菌株为D试验阳性，其余51株（18.34%）菌株为D试验阴性。
鉴于D试验阳性金黄色葡萄球菌菌株的高流行率，以及社区和医院部门多药耐药菌株同样高的流行率，对于化脓性感染可能应常规进行D试验。
