耐利奈唑胺头状葡萄球菌耐药性及患者临床特征
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李一荣

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R446.5

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国家科技重大专项课题(十三五)(2017ZX10103005)


Drug resistance of linezolid-resistant Staphylococcus capitis and clinical characteristics of patients
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    摘要:

    目的 了解耐利奈唑胺头状葡萄球菌的耐药机制以及临床特征。方法 收集某院分离的耐利奈唑胺头状葡萄球菌,采用脉冲场凝胶电泳(PFGE)分析菌株的同源性,PCR方法扩增23S rRNA基因、编码核糖体蛋白L3和L4的基因(rplC、rplD),以及耐药基因CFR,并测序。结果 5例患者标本分离7株耐利奈唑胺头状葡萄球菌,其对苯唑西林、左氧氟沙星、庆大霉素等常用抗菌药物耐药,仅对糖肽类、利福平、四环素,奎奴普丁/达福普汀敏感。7株耐药菌23S rRNA均存在突变,均不携带CFR基因。PFGE显示,7株临床株属同一谱型。5例患者均有严重的基础疾病,分离出耐药菌的住院时间92 d~10个月,其中3例患者深静脉置管,1例同时深静脉、透析置管,3例曾接受利奈唑胺治疗。结论 7株头状葡萄球菌对利奈唑胺耐药是由于23S rRNA第V区G2576T和C2104T突变导致;利奈唑胺耐药头状葡萄球菌呈多重耐药表型,患有基础疾病、长期住院、长疗程使用利奈唑胺和深静脉置管可能是患者感染此类耐药菌的危险因素。

    Abstract:

    Objective To understand drug resistance mechanism and clinical characteristics of linezolid-resistant Staphylococcus capitis(LRSC). Methods LRSC isolated from a hospital was collected, homology of the strains was analyzed by pulsed-field gel electrophoresis(PFGE), 23S rRNA gene, rplC and rplD genes which encode ribosomal protein L3 and L4, as well as drug-resistant gene CFR were amplified by polymerase chain reaction(PCR), then sequenced. Results Seven strains of LRSC were isolated from specimens of 5 patients, strains were resistant to oxacillin, levofloxacin, gentamicin and other commonly used antimicrobial agents, only susceptible to glycopeptides, rifampicin, tetracycline and quinupristin/dalfopristin. 23S rRNA mutation were found in all 7 drug-resistant strains, all strains didn't carry CFR gene. PFGE showed that 7 clinical strains belonged to the same genotype. All 5 patients had serious underlying diseases, length of hospital stay of patients who isolated drug-resistant bacteria was 92 days to 10 months, 3 of whom indwelled deep venous catheters, 1 patient indwelled both deep venous catheter and dialysis catheter, and 3 patients received linezolid treatment. Conclusion Resistance of 7 strains of S. capitis to linezolid is due to G2576T and C2104T mutations in V region of 23S rRNA; LRSC showed multidrug-resistant phenotype, factors for drug-resistant bacterial infection may be patients with underlying diseases, prolonged length of hospital stay, long course of treatment with linezolid and indwelling deep vein catheter.

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方芳, 李雪寒, 李一荣.耐利奈唑胺头状葡萄球菌耐药性及患者临床特征[J]. 中国感染控制杂志,2019,18(10):917-923. DOI:10.12138/j. issn.1671-9638.20195207.
FANG Fang, LI Xue-han, LI Yi-rong. Drug resistance of linezolid-resistant Staphylococcus capitis and clinical characteristics of patients[J]. Chin J Infect Control, 2019,18(10):917-923. DOI:10.12138/j. issn.1671-9638.20195207.

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  • 收稿日期:2019-03-19
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  • 在线发布日期: 2019-10-28
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