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目的观察住院婴儿呼吸道脲原体的生物群构成和耐药情况,为预防和治疗婴儿脲原体感染提供依据。方法于2012年11月—2015年12月1日采集某综合性三甲儿童医院住院婴儿鼻咽部咽拭子(痰液)标本,采用Mycoplasma IST-2(bio Merieux)试剂盒对标本进行培养鉴定及药敏试验,采用PCR方法进行脲原体生物分群、红霉素甲基化酶(ermA、ermB、ermC)和主动外排泵(mef A/E、msr A/B、mre A)可转移耐药基因检测。比较不同生物群脲原体对9种常见抗生素耐药率和红霉素耐药基因检出率差异。结果 78株脲原体培养阳性,其中48株(61.54%)脲原体分离自早产儿。生物1群51株,占65.38%;生物2群27株,占34.62%。不同生物群在患儿性别、是否早产儿、年龄、出生胎龄、出生体重及住院天数等方面差异均无统计学意义(P>0.05)。78株脲原体对环丙沙星和氧氟沙星的耐药率较高,均为80.77%;对四环素的耐药率为1.28%;对多西环素、交沙霉素和原始霉素高度敏感;对大环内酯类抗生素(红霉素、阿奇霉素和克拉霉素)耐药率较低,均<12%。不同生物群对这9种抗生素的耐药率差异均无统计学意义(P>0.05)。仅有甲基化酶耐药基因(ermB)、主动外排泵可转移耐药基因(msr A/B)阳性扩增,检出率分别为39.74%和12.82%。ermB主要存在于生物2群,检出率为55.56%(P<0.05),msr A/B在脲原体两大生物群中分布较均衡(P>0.05)。78株脲原体分别来自新生儿败血症24例,先天感染性肺炎30例,早产儿视网膜病9例,新生儿颅内出血9例,支气管肺发育不良15例。这些疾病在生物1群和2群的分布差异均无统计学意义(P>0.05)。结论婴儿呼吸道分离的脲原体以生物1群为主,在早产儿中检出率更高;对大环内酯类抗生素耐药率较低,可作为治疗婴儿脲原体感染的首选药物;红霉素耐药基因ermB主要分布在生物2群。
Objective To observe the composition and drug resistance of urethral respiratory tract urethritis in hospitalized infants, and to provide basis for the prevention and treatment of Ureaplasma urealyticum infection. Methods Nasopharyngeal throat swabs (sputum samples) of hospitalized infants from a comprehensive three-child hospital were collected from November 2012 to December 1, 2015. Mycoplasma IST-2 (bio Merieux) kit was used to identify the samples And drug susceptibility test, the bioassay of Ureaplasma urealyticum was carried out by PCR. Erythromycin methylase (ermA, ermB, ermC) and active efflux pump (mef A / E, msr A / B, mre A) Resistance gene test. The differences of drug resistance rate and erythromycin resistance gene detection rate between different biotypes of Ureaplasma urealyticum were compared. Results 78 strains of Ureaplasma were cultured positive, of which 48 strains (61.54%) of Ureaplasma isolated from premature children. There are 51 strains of organisms in one group, accounting for 65.38%. There are 27 species in 2 groups, accounting for 34.62%. There was no significant difference in gender, preterm birth, age, gestational age, birth weight and number of days of hospitalization among different biomes (P> 0.05). 78 strains of ureaplasma urealyticum ciprofloxacin and ofloxacin resistant rates were higher, were 80.77%; tetracycline resistance rate was 1.28%; doxycycline, josamycin and original mold Highly sensitive; macrolide antibiotics (erythromycin, azithromycin and clarithromycin) lower resistance rate, were <12%. There was no significant difference in resistance rate among the 9 different antibiotics among different biota (P> 0.05). Only methylergic resistance gene (ermB) and active efflux pump transferable gene (msr A / B) were positive. The detection rates were 39.74% and 12.82% respectively. ErmB mainly existed in two groups of organisms, with a detection rate of 55.56% (P <0.05). The distribution of msr A / B was more balanced among the two biota of Ureaplasma urealyticum (P> 0.05). 78 strains of ureaplasma were from neonatal sepsis in 24 cases, 30 cases of congenital pneumonia, retinopathy of prematurity in 9 cases, 9 cases of neonatal intracranial hemorrhage, bronchopulmonary dysplasia in 15 cases. There was no significant difference in the distribution of these diseases between the first group and second group (P> 0.05). Conclusion The ureaplasma isolated from respiratory tract of infants is mainly dominated by organism group 1, with a higher detection rate in preterm infants, lower resistance to macrolide antibiotics and the drug of choice for the treatment of ureaplasma urealyticum infection. Erythromycin resistance gene ermB is mainly distributed in two groups of organisms.