临床分离金黄色葡萄球菌的耐药特点和MRSA分子分型
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刘志钢

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R181.3+2 R378.1+1

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武汉市卫生和计划生育委员会科研项目(WG16B09)


Antimicrobial resistance features and molecular typing of clinically isolated methicillinresistant Staphylococcus aureus
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    摘要:

    目的研究耐甲氧西林金黄色葡萄球菌(MRSA)的耐药性及其基因分型。方法收集某院2014年1月—2015年11月检出的非重复金黄色葡萄球菌967株,检测其药敏结果及mecA抗性基因、杀白细胞素(PVL)基因;MRSA菌株经多重PCR进行葡萄球菌盒式染色体mec(SCCmec)分型、多位点序列分型(MLST)、金黄色葡萄球菌蛋白A基因(spa)分型、金黄色葡萄球菌附属因子调节子(agr)分型。结果967株金黄色葡萄球菌共检出210株MRSA,MRSA检出率为21.72%;痰标本MRSA检出率高于皮肤软组织标本(68.09% vs 11.83%,P<0.05);金黄色葡萄球菌中未发现对万古霉素和利奈唑胺耐药菌株,MRSA对庆大霉素、四环素、红霉素、克林霉素、左氧氟沙星、环丙沙星、莫西沙星、呋喃妥因、利福平的敏感率均低于MSSA,差异均有统计学意义(均P<0.05);MRSA对复方磺胺甲口恶唑的敏感率高于MSSA,差异有统计学意义(P<0.05)。皮肤软组织分离的MRSA对庆大霉素、左氧氟沙星、环丙沙星、莫西沙星、利福平的敏感率为86.90%~95.24%,而痰分离的MRSA仅为1.56%~15.63%。967株金黄色葡萄球菌检测出210株携带mecA基因,10株携带PVL基因,210株MRSA 中有8株未分型,占3.81%。MLST主要以ST 239(177株)为主;SCCmec分型主要以Ⅲ型(177株)为主;spa分型主要以t 030(177株)为主;agr分型主要以Ⅰ型(196株)为主。结论该院MRSA菌株主要流行克隆ST239MRSASCCmecⅢt030,耐药形势严峻,应加强医院内耐药菌株的监测。

    Abstract:

    ObjectiveTo study antimicrobial resistance and genotyping of methicillinresistant Staphylococcus aureus (MRSA). MethodsA total of 967 norepetitive strains of Staphylococcus aureus (S. aureus) isolated from a hospital between January 2014 and November 2015 were collected, antimicrobial susceptibility testing, mecA gene, and PantonValentine leukocidin gene (PVL gene) were detected; staphylococcal cassette chromosome mec(SCCmec) typing, multilocus sequence typing(MLST), S. aureus protein A(spa) gene typing, and S. aureus accessory gene regulator(agr) typing were performed with multiplex polymerase chain reaction. ResultsOf 967 strains of S. aureus,210 (21.72%) were MRSA; detection rate of MRSA from sputum specimen was higher than that of skin and soft tissue specimen(68.09% vs 11.83%, P<0.05); vancomycin and linezolidresistant S. aureus strains were not found, susceptibility rates of MRSA to gentamicin, tetracycline, erythromycin, clindamycin, levofloxacin, ciprofloxacin, moxifloxacin, nitrofurantoin, and rifampicin were all lower than those of methicillinsensitive Staphylococcus aureus (MSSA), differences were all statistically significant(all P<0.05);antimicrobial susceptibility rate of MRSA to compound sulfamethoxazole was higher than MSSA, difference was significant(P<0.05). Susceptibility rates of MRSA isolated from skin and soft tissue to gentamicin, levofloxacin, ciprofloxacin, moxifloxacin, and rifampicin were 86.90%-95.24%,while MRSA isolated from sputum were only 1.56%-15.63%. Of 967 strains of S. aureus, 210 harbored mecA gene, 10 harbored PVL gene, 8(3.81%) of 210 MRSA strains weren’t typed. The main types of MLST, SCCmec, spa, and agr were ST 239 (n=177 strains), type Ⅲ(n=177 strains), t 030 (n=177 strains), and typeⅠ(n=196 strains) respectively. ConclusionThe main epidemic clone of MRSA strain in this hospital is ST239MRSASCCmec IIIt030, antimicrobial resistance is serious, monitoring on drugresistant strains in hospital should be strengthened.

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贾珉, 江元山, 朱建华,等.临床分离金黄色葡萄球菌的耐药特点和MRSA分子分型[J]. 中国感染控制杂志,2018,17(4):289-293. DOI:10.3969/j. issn.1671-9638.2018.04.003.
JIA Min, JIANG Yuanshan, ZHU Jianhua, et al. Antimicrobial resistance features and molecular typing of clinically isolated methicillinresistant Staphylococcus aureus[J]. Chin J Infect Control, 2018,17(4):289-293. DOI:10.3969/j. issn.1671-9638.2018.04.003.

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  • 收稿日期:2017-06-12
  • 最后修改日期:2017-08-23
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  • 在线发布日期: 2018-04-26
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