摘要目的 探讨天津市猩红热患儿A组链球菌(GAS)对抗菌药物的耐药特征,以便指导临床用药.方法 连续6年采集猩红热患儿咽拭子标本进行GAS菌株分离,对276株GAS进行药物敏感性试验,并用PCR方法进行emm分型.结果 276株GAS对青霉素、头孢唑啉和万古霉素敏感率均为100％,对氯霉素和左氧氟沙星敏感率均为98.2％,对阿奇霉素耐药率最高达97.8％,其次为红霉素(97.1％)、克拉霉素和克林霉素(均为94.2％)、四环素(79.3％).耐药模式中GAS对红霉素、阿奇霉素、克拉霉素、克林霉素和四环素联合耐药占73.2％.来源于不同年份的的GAS菌株对四环素、克林霉素、克拉霉素、红霉素和阿奇霉素的耐药率差异均有统计学意义.emm12型GAS对四环素的耐药率为84.0％,高于emm1型GAS对四环素的耐药率(59.5％),差异有统计学意义(χ2=13.820,P=0.000).结论 天津市猩红热患儿分离的GAS以耐大环内酯类抗生素、克林霉素和四环素为主,提示临床谨慎选择该类药物.GAS感染仍首选青霉素,对青霉素过敏者可选头孢菌素类抗生素替代.

abstractsObjective To analyze the characteristics of antibiotic resistance in group A Streptococ-cus ( GAS) strains isolated from children with scarlet fever in Tianjin in order to provide reference for clinical drug administration. -ethods GAS strains were collected from 2011 to 2016. A total of 276 isolates were analyzed by antibiotic susceptibility test and emm typing. Results All of the isolates were susceptible to penicillin, cefazolin and vancomycin, while 98. 2％ were susceptible to both chloramphenicol and levofloxa-cin. The resistance rates to azithromycin, erythromycin, clarithromycin, clindamycin and tetracycline were 97. 8％, 97. 1％, 94. 2％, 94. 2％ and 79. 3％. The concomitant resistance to erythromycin, azithromycin, clarithromycin, clindamycin and tetracycline was 73. 2％. The resistance rates of GAS strains isolated from different years to tetracycline, clindamycin, clarithromycin, erythromycin and azithromycin were significantly different. A statistically significant difference was found between the percentages of emm12 and emm1 strains resistant to tetracycline (84. 0％ vs 59. 5％, χ2=13. 820, P=0. 000). Conclusions The isolated GAS strains are sensitive toβ-lactams and highly resistant to macrolide antibiotics, clindamycin and tetracycline. Penicillin remains the preferred treatment for GAS infection and cephalosporins may be used as a substitute if the patient is allergic to penicillin.