摘要:
Objective To monitor the resistance of Neisseria gonorrhoeae to azithromycin and the distribution of resistance to azithromycin gonococcal strains in 11 regions of Guangdong Province ,and the epidemic trends of resistance to azithromycin gonococcal strains in Guangzhou from 2013 to 2018 ,providing guidance for clinical treatment and control. Methods The clinical isolates of Neisseria gonorrhoeae were collected from 11 regions of Guangdong in 2018 and Guangzhou from 2013 to 2018. The minimum inhibitory concentrations (MICs) of azithromycin against the isolates were quantified through the agar dilution method or microdilution method. The susceptibility of isolates was judged with WHO recommendation,and was compared among different regions or years. Results The MIC50 and MIC90 of 1178 isolates from Guangdong in 2018 were 0.5 and 1mg/L,and the MIC90 reached the critical value (MIC≥1 mg/L). Seven regions reached or exceeded this critical value. The resistance to azithromycin rate in Guangdong was 20.03%(236/1178); and in Shenzhen was 14.29%(31/217),which was significantly lower than that in Guangdong (χ2=3.912,P<0.05). The resistance to azithromycin rate in Zhongshan was 40.21% (39/71),which was significantly higher than that in Guangdong (χ2=21.558,P<0.01). The MIC50 and MIC90 of 624 isolates from Guangzhou in 2013-2018 were 0.5 and 1 mg/L,and the MIC90 also reached the critical value (MIC≥1 mg/L). The MICs of azithromycin exceeded the critical value in these strains isolated in 2016 and 2018 (MIC90=2 mg/L). The resistance to azithromycin rate increased from 11.90%(10/84) to 23.49% (39/166) in 2013-2018,showing a significant upward trend (χ2trend=6.276,P<0.05). Conclusions The resistance to azithromycin rate is high in 11 regions of Guangdong Province. The prevalence rates of resistance to azithromycin gonococcus in Shenzhen and Zhongshan are lower and higher than the general level,respectively. And the epidemic trend of resistance to azithromycin gonococcus increased significantly from 2013 to 2018 in Guangzhou,and azithromycin should be used according to the result of antibiotic susceptibility testing.%目的 了解广东省11个地区阿奇霉素耐药淋病奈瑟球菌(淋球菌)的现状及各地区阿奇霉素耐药淋球菌的分布特征,并分析广州市2013—2018年阿奇霉素耐药淋球菌菌株的流行趋势,为指导临床合理用药和控制淋病传播提供科学依据.方法 收集2018年广东省11个地区以及2013—2018年广州市淋球菌临床分离株,采用琼脂稀释法或改良的微量稀释法检测阿奇霉素对分离株的最低抑菌浓度(MIC),根据WHO推荐标准判断耐药性,并进行各地区或各年份间MIC和耐药率的比较.结果 2018年广东省11个地区1178株淋球菌对阿奇霉素的总体MIC50为0.5 mg/L,MIC90为1 mg/L,已达到耐药的临界值(≥1 mg/L),其中有7个地区达到或超过该临界值.全省阿奇霉素耐药淋球菌发生率为20.03%(236/1178),其中深圳的阿奇霉素耐药淋球菌发生率为14.29%(31/217),低于全省总体水平(χ2=3.912,P<0.05);中山的阿奇霉素耐药淋球菌发生率为40.21%(39/71),高于全省总体水平(χ2=21.558,P<0.01).2013—2018年,广州市共检测624株淋球菌对阿奇霉素的总体MIC50为0.5 mg/L,MIC90为1 mg/L,MIC90同样达到阿奇霉素耐药淋球菌的临界值(≥1 mg/L);2016年和2018年MIC90为2 mg/L,已超过临界值.2013—2018年广州市阿奇霉素耐药淋球菌从11.90%(10/84)升高至23.49%(39/166),呈显著升高趋势(χ2趋势=6.276,P<0.05).结论 广东省11个地区流行淋球菌对阿奇霉素耐药率较高,深圳市和中山市阿奇霉素耐药淋球菌发生率分别低于和高于总体水平.2013—2018年间广州市阿奇霉素耐药淋球菌流行显著升高.临床应结合药物敏感性实验结果选择性使用阿奇霉素.