中南地区金黄色葡萄球菌流行病学及耐药性研究  

Epidemiology and antibiotic resistance of Staphylococcus aureus strains in south central China

作　　者：刘彩林[1] 陈中举[1] 孙自镛[1] 曹伟[2] 冯羡菊[3] 王山梅[4] 曾吉[5] 邹明祥[6] 汪明[1] 孙明月[1] 侯红艳[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院检验科,武汉430030 [2]中南大学湘雅二医院检验科 [3]郑州大学第一附属医院检验科 [4]河南省人民医院检验科 [5]华中科技大学同济医学院附属协和医院检验科 [6]中南大学湘雅医院检验科

出　　处：《中华微生物学和免疫学杂志》2013年第6期410-415,共6页Chinese Journal of Microbiology and Immunology

基　　金：国家“十二五”科技重大专项子课题（2012ZX10004207-004）

摘　　要：目的研究中南地区2011年6月至2012年5月金黄色葡萄球菌的耐药情况及基因型分布。方法采用琼脂稀释法检测金黄色葡萄球菌对临床常用抗菌药物的最小抑菌浓度（MIC），多重PCR方法对MRSA菌株进行SCCmec（staphylococcalcassettechromosomemec）和agr（accessorygeneregulator）分型。用MHAST（含有5μg／ml替考拉宁的M—H琼脂）初筛hVISA（heterogeneousvall-comycin—intermediateStapylococcusaarells）菌株，MHAST初筛阳性的菌株用金标准PAP／AUC法（popu—lationanalysisprofile／areaunderthecurve）进行确证。结果352株金黄色葡萄球菌主要分离自血液标本（40．1％）和分泌物标本（24．7％），其中耐甲氧西林金黄色葡萄球菌（MRSA）118株，检出率为33．5％。MRSA菌株对头孢菌素类、氨基糖苷类、β-内酰胺类、氟喹诺酮类、利福平、克林霉素、红霉素和四环素等抗菌药物耐药率均显著高于MSSA，差异有统计学意义（P〈0．05）。MRSA对氯霉素和甲氧苄啶／磺胺甲嗯唑耐药率较低，分别为10．2％和7．4％，未发现万古霉素、替考拉宁、利奈唑胺、达托霉素及替加环素耐药的菌株。118株MRSA中共检测出hVISA20株，检出率为16．9％。MRSA菌株主要为SCCmecⅢ型，占80．5％；其次是Ⅳ型占8．5％。agr分型主要为agr．1型，占81．4％；其次为agr-2型，占15．3％。结论中南地区金黄色葡萄球菌耐药现象严重，MRSA基因型主要为SCCmecllI型和agr-1型，hVISA流行率极高，达16．9％，应引起临床高度重视，合理使用抗菌药物尤其是糖肽类药物，以避免VISA和VRSA（vancomycin—resistantStapylococcusattreus）株的产生，致使临床治疗失败。Objective To investigate the genotype distribution and antibiotic resistance of Stapylo- coccus aureus strains isolated from June 2011 to May 2012 in south central China. Methods The minimum inhibitory concentrations （MIC） of antibiotics were determined by agar dilution method. SCCmec （staphylo- coccal cassette chromosome mec） and agr （accessory gene regulator） typing on MRSA strains were per- formed using multiplex PCR. The hVISA （heterogeneous vancomycin-intermediate Stapylococcus aureus） strains were screened with MH5TT-screening agar （Mueller-Hinton agar containing 5 μg/ml teicoplanin） and the positive strains were further confirmed by PAP-AUC method （population analysis profile-area under conclusive evidence of the curve）. Results A total of 352 consecutive and non-repetitive Stapylococcus au- reus strains were isolated mainly from blood samples （40.1%） and secretion samples （24.7%）, of which 118 strains were methicillin-resistant Stapylococcus aureus （MRSA） with a prevalence rate of 33.5%. The rates of antibiotic resistance of MRSA strains to cephalosporins, aminoglycosides, β-lactams, fluoroquinolo- nes, rifampin, clindamycin, erythromycin and tetracycline were significantly higher than those of MSSA strains （P〈0.05）, but the rates of antibiotic resistance of MRSA to chloramphenicol and trimethoprim/sul- famethoxazole were relatively low, which were 10.2% and 7.4%, respectively. Strains resistant to vancomycin, teicoplanin, linezolid, daptomycin or tigecycline were not found. Twenty hVISA strains were detec- ted from MRSA strains with a prevalence rate of 16.9%. The results of SCCmec typing showed that the dom- inant genotype of MRSA strains was SCCmec type m, accounting for 80.5%, followed by type IV, account- ing for 8.5%. There were two main types identified by agr typing, of which 81.4% were of agr-1 type and 15.3% were of agr-2 type. Conclusion SCCmec type ~[ and agr-1 type were the dominant genotypes of MRSA strains, and hVISA strains had a high prevalence

关 键 词：金黄色葡萄球菌 耐甲氧西林金黄色葡萄球菌 HVISA SCCMEC 

分 类 号：R446[医药卫生—诊断学]