摘要或動機

A total of 64 nonduplicate isolates of erythromycin-resistant (MIC, >1 μg/ml) Streptococcus pyogenes collected from 1979 to 2003 in Taiwan were evaluated. They were collected from three cohort period: 1979 –1989, 1990-1999 and after 2000. The in vitro activities of 10 antimicrobial agents were determined by the agar dilution method. Penicillin, cephalothin, cefotaxime, vancomycin, and ofloxacin were shown to be active against S. pyogenes isolates (100% sensitive). Erythromycin and azithromycin both had poor activities (MIC50s, 16 and >128 μg/ml, respectively; MIC90s, >512 and >128 μg/ml, respectively). The activities of tetracycline, clindamycin, and chloramphenicol against a significant number of these isolates were also limited. Among the 64 S. pyogenes isolates, 58% had constitutive resistance [cMLS], 40% had an M phenotype and 2% had an iMLS phenotype (inducible resistance [iMLS]). A substantial upsurge in the incidence of M phenotype erythromycin-resistant isolates was found with time for S. pyogenes (10% in 1979–1989, 48% in 1990–1999 and 65% after 2000). The erythromycin resistance genes in 64 isolates of the different cohorts were investigated by PCR. All cMLS phenotype isolates tested had ermB gene. The M phenotype isolates had only the macrolide efflux (mefA) gene. This study shows the secular changes of increasing susceptibility of S. pyogenes isolates to both erythromycin and clindamycin in Taiwan. The mechanisms of erythromycin resistance have changed from the predominance of ermB gene (cMLS) to mefA gene (M phenotype). 本研究是探討台灣自1970 年代末期以來不同世代A群鏈球菌菌株對紅黴素的抗藥性及抗藥基因特徵的演變。研究者收集台灣二十年前(1980 年代前後，第一世代)、十年前(1990 年代，第二世代)、)及最近(2000 年以後，第三世代)之A 群鏈球菌菌株共64 株，利用抗生素圖譜和雙藥錠擴散測試及聚合?連鎖反應(PCR)、和脈衝式膠體電泳研究A 群鏈球菌對紅黴素抗藥性的表現型及基因型特徵。結果發現第一世代的A 群鏈球菌對紅黴素最小抑菌濃度(MIC)值相當高，幾乎都是>512 μg/ml，90%為多重抗藥菌株。第二世代則相對有降低，在第三世代此現象更明顯，多重抗藥菌株為30%。在雙藥錠擴散測試結果，從第一世代來看cMLS 佔大多數(90%)，M 型佔10%；第二世代cMLS 及M 型相當分別佔52%及48%；第三世代主要為M 型佔65%，cMLS 佔30%，iMLS 佔5%。利用PCR研究紅黴素抗藥性基因發現所有cMLS 菌株皆有ermB 基因，所有M 型菌株皆有mefA 基因，iMLS 菌株則有ermTR 基因。由本研究顯示在台灣A 群鏈球菌對紅黴素之抗藥性隨著不同世代有逐年改善之趨勢，由MIC50的降低可看出，菌株對紅黴素的敏感性提高，可為臨床治療之參考。