引起皮肤和软组织放线菌病的放线菌的鉴定和药敏分析

doi:10.3969/j.issn.1673-8640.2026.10.012

摘要/Abstract

摘要：

目的探讨引起皮肤和软组织放线菌病的放线菌临床分离株鉴定方法，并分析放线菌对17种抗菌药物的敏感性，为临床治疗放线菌病提供参考。方法收集2022年1月—2024年6月清华大学北京清华长庚医院分离自22例皮肤和软组织放线菌感染患者的24株放线菌。采用基质辅助激光解吸电离飞行时间质谱（MALDI-TOF MS）和16S rRNA基因测序确证菌株类型。采用BLAST比对16S rRNA基因测序数据，并进行物种鉴定。采用E试验检测放线菌对17种抗菌药物的最小抑菌浓度（MIC）。结果 24株放射菌中，雷丁放线菌11株、欧洲放线菌6株、苏黎世放线菌4株、诺伊放线菌3株。大多数放线菌对青霉素、阿莫西林/克拉维酸、头孢曲松、亚胺培南、美罗培南、利奈唑胺、万古霉素、米诺环素和多西环素的MIC值较低，对红霉素、克拉霉素、环丙沙星、左氧氟沙星、克林霉素和复方磺胺甲噁唑的MIC值较高。结论 MALDI-TOF MS和16S rRNA基因测序放线菌鉴定结果一致。放线菌属对多种β-内酰胺类药物敏感性均较高，可作为首选抗菌药物。对于青霉素过敏患者，米诺环素和多西环素也是较优的抗菌药物选择。

关键词: 放线菌, 质谱, 16S rRNA, E试验

Abstract:

Objective To investigate the identification methods for clinical isolates of Actinomycetes causing cutaneous and soft tissue actinomycosis，and to analyze their susceptibility to 17 antimicrobial agents and provide a reference for clinical treatment. Methods Totally，24 isolates of Actinomycetes from 22 patients with cutaneous and soft tissue actinomycosis were collected at Beijing Tsinghua Changgung Hospital of Tsinghua University from January 2022 to June 2024. Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry（MALDI-TOF MS） and 16S rRNA gene sequencing were used for species identification. 16S rRNA gene sequencing data were compared by BLAST. Minimum inhibitory concentrations（MIC） of 17 antimicrobial agents against Actinomycetes were determined using E-test. Results Among the 24 Actinomycetes isolates，Actinomycetes radingae accounted for 11 isolates，Actinomycetes europaeus for 6 isolates，Actinomycetes turicensis for 4 isolates，and Actinomycetes neuii for 3 isolates. The most isolates exhibited low MIC values to penicillin，amoxicillin/clavulanate，ceftriaxone，imipenem，meropenem，linezolid，vancomycin，minocycline and doxycycline. High MIC values were observed against erythromycin，clarithromycin，ciprofloxacin，levofloxacin，clindamycin and trimethoprim-sulfamethoxazole. Conclusions The results from MALDI-TOF MS and 16S rRNA gene sequencing are consistent. Actinomycetes generally demonstrate high susceptibility to various beta-lactam antibiotics，which can be considered as first-line treatments. For patients allergic to penicillin，minocycline and doxycycline are also preferred alternatives.

Key words: Actinomycetes, Mass spectrometry, 16S rRNA, E-test

中图分类号:

R446.1

魏田利, 肖楠, 祝天阳, 段宁, 赵秀英. 引起皮肤和软组织放线菌病的放线菌的鉴定和药敏分析[J]. 检验医学, 2026, 41(10): 1012-1017.

WEI Tianli, XIAO Nan, ZHU Tianyang, DUAN Ning, ZHAO Xiuying. Identification and antimicrobial susceptibility analysis of Actinomycetes causing cutaneous and soft tissue actinomycosis[J]. Laboratory Medicine, 2026, 41(10): 1012-1017.

图/表 2

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抗菌药物	雷丁放线菌
抗菌药物	第1株	第2株	第3株	第4株	第5株	第6株	第7株	第8株	第9株		第10株		第11株
青霉素	0.024	0.012	0.032	0.064	0.250	0.064	0.064	0.016	0.064		0.024		0.024
阿莫西林-克拉维酸	0.016	<0.008	0.016	0.032	0.032	0.032	<0.008	<0.008	0.032		<0.008		<0.008
头孢曲松	0.064	0.032	0.125	0.190	0.750	0.190	0.064	0.032	0.190		0.125		0.032
亚胺培南	0.016	0.008	0.016	0.024	0.032	0.024	0.016	0.024	0.032		0.016		0.012
美罗培南	0.125	0.064	0.125	0.190	0.250	0.125	0.125	0.125	0.380		0.190		0.094
利奈唑胺	0.125	0.250	0.250	0.125	0.250	0.250	0.125	0.250	0.250		0.250		0.250
万古霉素	0.250	0.250	0.250	0.380	0.500	0.500	0.380	0.500	0.380		0.380		0.380
红霉素	>256	>256	>256	>256	>256	>256	>256	>256	>256		>256		>256
克拉霉素	>32	>32	>32	>32	>32	>32	>32	>32	>32		>32		>32
庆大霉素	8	16	2	4	8	8	4	8	8		4		4
妥布霉素	16	64	8	32	64	64	16	64	64		32		32
环丙沙星	>32	0.125	>32	>32	0.064	0.250	>32	>32	0.125		>32		>32
左氧氟沙星	>32	0.250	>32	>32	0.125	0.250	>32	>32	0.250		>32		>32
米诺环素	0.125	1	0.250	0.125	0.125	0.250	0.250	0.125	0.125		0.125		0.250
多西环素	0.250	8	0.500	0.125	0.500	0.250	1	0.125	0.250		0.250		0.250
克林霉素	>256	>256	>256	>256	>256	>256	>256	>256	>256		>256		>256
复方磺胺甲噁唑	>32	>32	>32	>32	>32	>32	>32	>32	>32		>32		>32
抗菌药物	欧洲放线菌						苏黎世放线菌				诺伊放线菌
抗菌药物	第1株	第2株	第3株	第4株	第5株	第6株	第1株	第2株	第3株	第4株	第1株	第2株		第3株
青霉素	0.048	0.024	0.380	0.500	0.380	0.032	0.125	0.008	0.125	0.125	0.016	0.008		0.016
阿莫西林/克拉维酸	0.032	<0.008	0.125	<0.008	0.125	<0.008	0.125	<0.008	0.125	0.064	<0.008	<0.008		<0.008
头孢曲松	0.190	0.032	0.500	1.500	1.500	0.190	0.190	0.016	0.125	0.125	0.016	0.032		0.048
亚胺培南	0.125	0.032	0.190	0.380	0.500	0.064	0.064	0.012	0.094	0.048	0.008	0.008		0.016
美罗培南	0.125	0.024	0.190	0.380	0.250	0.048	0.190	0.024	0.190	0.125	0.008	0.008		0.016
利奈唑胺	0.250	0.250	0.125	0.250	0.250	0.250	0.250	0.250	0.250	0.250	0.250	0.250		0.250
万古霉素	0.380	0.380	0.380	0.380	0.380	0.250	0.380	0.380	0.380	0.500	0.380	0.380		0.380
红霉素	0.125	>256	>256	>256	>256	<0.064	2	>256	>256	0.064	0.064	16		<0.064
克拉霉素	0.016	16	>32	>32	>32	0.016	0.250	>32	8	0.016	0.016	0.500		0.008
庆大霉素	2	2	>256	4	>256	4	2	2	4	1	4	4		2
妥布霉素	4	4	64	4	>256	4	4	8	8	4	8	4		4
环丙沙星	>32	0.500	>32	>32	>32	>32	>32	>32	>32	>32	2	2		1
左氧氟沙星	>32	1	>32	>32	>32	>32	>32	4	8	>32	2	2		1
米诺环素	2	0.125	0.064	0.064	1	2	2	0.064	0.064	0.064	0.125	0.064		0.064
多西环素	4	0.125	0.125	0.250	8	8	4	0.250	0.125	0.125	0.500	0.250		0.250
克林霉素	0.250	>256	>256	>256	>256	0.125	<0.064	>256	>256	<0.064	0.125	>256		<0.064
复方磺胺甲噁唑	>32	>32	>32	>32	>32	>32	2	0.500	0.125	<0.008	0.500	0.032		0.032

抗菌药物	雷丁放线菌
抗菌药物	第1株	第2株	第3株	第4株	第5株	第6株	第7株	第8株	第9株		第10株		第11株
青霉素	0.024	0.012	0.032	0.064	0.250	0.064	0.064	0.016	0.064		0.024		0.024
阿莫西林-克拉维酸	0.016	<0.008	0.016	0.032	0.032	0.032	<0.008	<0.008	0.032		<0.008		<0.008
头孢曲松	0.064	0.032	0.125	0.190	0.750	0.190	0.064	0.032	0.190		0.125		0.032
亚胺培南	0.016	0.008	0.016	0.024	0.032	0.024	0.016	0.024	0.032		0.016		0.012
美罗培南	0.125	0.064	0.125	0.190	0.250	0.125	0.125	0.125	0.380		0.190		0.094
利奈唑胺	0.125	0.250	0.250	0.125	0.250	0.250	0.125	0.250	0.250		0.250		0.250
万古霉素	0.250	0.250	0.250	0.380	0.500	0.500	0.380	0.500	0.380		0.380		0.380
红霉素	>256	>256	>256	>256	>256	>256	>256	>256	>256		>256		>256
克拉霉素	>32	>32	>32	>32	>32	>32	>32	>32	>32		>32		>32
庆大霉素	8	16	2	4	8	8	4	8	8		4		4
妥布霉素	16	64	8	32	64	64	16	64	64		32		32
环丙沙星	>32	0.125	>32	>32	0.064	0.250	>32	>32	0.125		>32		>32
左氧氟沙星	>32	0.250	>32	>32	0.125	0.250	>32	>32	0.250		>32		>32
米诺环素	0.125	1	0.250	0.125	0.125	0.250	0.250	0.125	0.125		0.125		0.250
多西环素	0.250	8	0.500	0.125	0.500	0.250	1	0.125	0.250		0.250		0.250
克林霉素	>256	>256	>256	>256	>256	>256	>256	>256	>256		>256		>256
复方磺胺甲噁唑	>32	>32	>32	>32	>32	>32	>32	>32	>32		>32		>32
抗菌药物	欧洲放线菌						苏黎世放线菌				诺伊放线菌
抗菌药物	第1株	第2株	第3株	第4株	第5株	第6株	第1株	第2株	第3株	第4株	第1株	第2株		第3株
青霉素	0.048	0.024	0.380	0.500	0.380	0.032	0.125	0.008	0.125	0.125	0.016	0.008		0.016
阿莫西林/克拉维酸	0.032	<0.008	0.125	<0.008	0.125	<0.008	0.125	<0.008	0.125	0.064	<0.008	<0.008		<0.008
头孢曲松	0.190	0.032	0.500	1.500	1.500	0.190	0.190	0.016	0.125	0.125	0.016	0.032		0.048
亚胺培南	0.125	0.032	0.190	0.380	0.500	0.064	0.064	0.012	0.094	0.048	0.008	0.008		0.016
美罗培南	0.125	0.024	0.190	0.380	0.250	0.048	0.190	0.024	0.190	0.125	0.008	0.008		0.016
利奈唑胺	0.250	0.250	0.125	0.250	0.250	0.250	0.250	0.250	0.250	0.250	0.250	0.250		0.250
万古霉素	0.380	0.380	0.380	0.380	0.380	0.250	0.380	0.380	0.380	0.500	0.380	0.380		0.380
红霉素	0.125	>256	>256	>256	>256	<0.064	2	>256	>256	0.064	0.064	16		<0.064
克拉霉素	0.016	16	>32	>32	>32	0.016	0.250	>32	8	0.016	0.016	0.500		0.008
庆大霉素	2	2	>256	4	>256	4	2	2	4	1	4	4		2
妥布霉素	4	4	64	4	>256	4	4	8	8	4	8	4		4
环丙沙星	>32	0.500	>32	>32	>32	>32	>32	>32	>32	>32	2	2		1
左氧氟沙星	>32	1	>32	>32	>32	>32	>32	4	8	>32	2	2		1
米诺环素	2	0.125	0.064	0.064	1	2	2	0.064	0.064	0.064	0.125	0.064		0.064
多西环素	4	0.125	0.125	0.250	8	8	4	0.250	0.125	0.125	0.500	0.250		0.250
克林霉素	0.250	>256	>256	>256	>256	0.125	<0.064	>256	>256	<0.064	0.125	>256		<0.064
复方磺胺甲噁唑	>32	>32	>32	>32	>32	>32	2	0.500	0.125	<0.008	0.500	0.032		0.032