医院耐甲氧西林葡萄球菌感染的生态学特征  

Ecological character of nosocomial infection causing by methicillinresistant coagulase-negative Staphylococci

作　　者：鲁辛辛[1] 郭拥军[1] 田晓波[1] 董云秋[1] 孙淑美[1] 

机构地区：[1]首都医科大学附属北京同仁医院检验科,北京100730

出　　处：《中华微生物学和免疫学杂志》2005年第10期859-862,共4页Chinese Journal of Microbiology and Immunology

基　　金：国家自然科学基金资助(30260106)

摘　　要：目的研究葡萄球菌医院感染的生态学特征,为β-内酰胺类抗生素过度使用导致的医院内肺感染提供预防措施。方法以多重耐药凝固酶阴性葡萄球菌作为主要研究对象,采用临床追踪、痰微生物种群定量分析、苯唑西林和头孢西丁耐药表型筛选以及mecA基因检测及序列同源性比较。结果30%(56/185)重症监护病人分离到耐药表型符合研究对象的葡萄球菌;感染与住院时间、病种、头孢哌酮/舒巴坦和亚胺培南使用有关,常与多重耐药鲍曼不动杆菌、阴沟肠杆菌、粪肠球菌、铜绿假单胞菌同时出现;当葡萄球菌超过细菌总数的50%时,应高度警惕继发感染和菌群失调;13%(24/185)病例以菌群交替为特征;64%(36/56)的病例凝固酶阴性葡萄球菌出现在亚胺培南或头孢哌酮/舒巴坦使用1周后;所有耐甲氧西林葡萄球菌菌株含1个533 bp的mecA基因;17株溶血葡萄球菌mecA基因间同源性为99.74%;56株葡萄球菌mecA基因的同源性是97.9%。结论从生态学的3个层面:宏观生态(医院环境、病人条件、抗生素使用等情况)、微生物生态(呼吸道微生物种群变化)、分子生态(mecA基因耐药基因同源性分析)分析葡萄球菌医院感染的特征,为控制医院感染提供新的思路。Objective To investigate the ecological character of nosocomial infectious by methicillin-resistant coagulase-negative Staphylococci （MRCNS）. Methods Fifty-six multiple-drug resistance CNS （MDRCNS） isolates were recovered firm the sputum of 185 patients in ICU and CCU wards, with clinical trail, micro-flora population quantitative analysis, selecting methicillin-resistant phenotype, determining mecA gene and comparing DNA sequences were carried out. Results MRCNS infection had been proved to be related with the infection, administration of cefoperazone/suihactam and imipenem, age, hospital staying and so on, and often contemporary with acinetobacter and E. cloacae. The count of CNS over 50% was recorded as hospital required infection. When using imipenem or cefoperazone/suibactam over one week, about 66% cases were positive for MDRCNS. All staphylococcal strains have a mecA gene of 533 bp. The different strains of Staphylococcus showed that between the homogeneous sequences were 97.9%. 17 strains S. haemolyt/cus have much similar DNA sequences（99.74% ） on gene. By the way, we found that the pair of primers could gain V583 section 10/11 the expect genome firm E.faecium （HLAIR） using identification bacterial species. Conclusion The ecological study of CNS（including macro-ecology, micro-flora population and mecA gene molecular ecology） had offered a new idea to control required hospital infections.

关 键 词：耐甲氧西林耐药葡萄球菌 医院感染 生态学特征 Β-内酰胺类抗生素 

分 类 号：R181.3[医药卫生—流行病学]