儿科血液和脑脊液来源表皮葡萄球菌的抗生素敏感性和mecA/icaA/icaD基因研究  

Study of antibiotics sensitivity and mecA/icaA/icaD genes of Staphylococcus epidermidis isolated from blood and CSF in children

作　　者：周明明[1] 沈月芳[1] 周建明[1] 叶青[1] 陈理华[1] 李建平[1] 陈学军[1] 

机构地区：[1]浙江大学医学院附属儿童医院,杭州310003

出　　处：《中国抗生素杂志》2013年第10期769-775,共7页Chinese Journal of Antibiotics

基　　金：浙江省教育厅基金项目(Y200909175);浙江省医药卫生科技计划资助项目(2011KYB045)

摘　　要：目的了解儿科血液和脑脊液来源表皮葡萄球菌的临床分布特征、抗生素敏感性和mecA/icaA/icaD基因的携带等情况,为临床表皮葡萄球菌感染的诊断和治疗提供一定的实验依据。方法儿科临床分离的表皮葡萄球菌采用VITEK 60全自动微生物分析仪结合GPI卡和GPS卡做常规鉴定和药敏,并运用WHONET5.4和SPSS13.0软件进行统计分析评价;用PCR方法检测mecA、icaA和icaD基因。结果 2010.01—2011.12期间,共检出442株表皮葡萄球菌,主要来自新生儿科110株(24.89%)、消化科72株(16.29%)、ICU 68株(15.38%)和呼吸科58株(13.12%);以血液来源为主(382株,86.43%)。所有表皮葡萄球菌中检出耐甲氧西林表皮葡萄球菌(MRSE)378株(85.52%),总的β-内酰胺酶阳性率为86.43%。除万古霉素、利奈唑胺和利福平外,MRSE对克林霉素、氨苄西林/舒巴坦、庆大霉素、苯唑西林、复方磺胺甲噁唑、莫西沙星、红霉素、呋喃妥因、左氧氟沙星、青霉素G、四环素的抗生素敏感率低于甲氧西林敏感表皮葡萄球菌(MSSE),其差异有统计学意义(P<0.05)。对MRSE敏感率高的抗生素主要为:利奈唑胺(100%)、万古霉素(100%)、利福平(95.8%)、呋喃妥因(98.7%)、莫西沙星(72.8%)、左氧氟沙星(72%)等,而对MSSE敏感率高的抗生素主要为:利奈唑胺(100%)、万古霉素(100%)、苯唑西林(100%)、呋喃妥因(100%)、利福平(98.4%)、氨苄西林/舒巴坦(98.4%)、莫西沙星(92.2%)、左氧氟沙星(92.2%)等。未发现万古霉素和利奈唑胺耐药的表皮葡萄球菌。血/脑脊液组(412株)和非血/脑脊液组(31株)、2010年(256株)和2011年组(186株)不同来源组表皮葡萄球菌对上述所有抗生素敏感率差异均无统计学意义。mecA、icaA、icaD基因在血培养来源(50株)分别与非血培养来源(23株)和环境皮肤来源(22株)表皮葡萄球菌中的检出率比较无显著性差异。结论儿科临床分离的表皮葡萄球菌主要源自血液标本,以新生儿�To investigate the antibiotic sensitivity and mecA/icaA/icaD status of Staphylococcus epidermidis （SE） in pediatric patients. Methods VITEK60 microbiology analyzer was used for identifying organisms and detecting antibiotic sensitivity. MecA, icaA and icaD were detected by PCRs. WHONET5.4 and SPSS13.0 softwares were employed for statistical analysis. Results The 442 SE strains were mainly isolated from neonatology （24.89%）, gastroenterology （16.29%）, intense care unit（icu, 15.38%） and respiratory （13.12%）, while the 442 strains were mainly isolated from blood （382, 86.43%）. Among these strains, methicillin-resistant Staphylococcus epidermidis （MRSE） accounted for 85.52%, while [3-Lactamase were 86.43%. Except for vancomycin, linezolid and rifampin, the sensitive rates of MRSE strains to clindamycin, ampicillin/sulbactam, gentamicin, oxicillin, trimeth/sulfa, moxifloxacin, erythromycin, nitrofurantoin, levofloxacin, pennicillin G, and tetracycline were significantly lower than those of methicillin-susceptible Staphylococcus epidermidis （MSSE） to the above antibiotics （P〈0.05）. The antibiotics with high sensitive rates for MRSE were vancomycin （100%）, linezolid （100%）, nitrofurantoin（98.7%）, rifampin （95.8%）, moxifloxacin （72.8%）, levofloxacin（72%）, while for MSSE were vancomycin （100%）, linezolid （100%）, oxicillin（100%）, nitrofurantoin（100%）, rifampin （98.4%）, ampicillin/sulbactam （98.4%）, moxifloxacin （92.2%）, levofloxacin（92.2%）. No SE with resistance to vancomycin and linezolid were found. There were no statistically significant differences of sensitivities to entire antibiotics between SE in blood/CSF group and non-blood/CSF group, or year 2010 group and year 2011 group. There were no statistically significant differences between SE isolated blood and non-blood in the rates of mecA, icaA or icaD genes. Conclusion SE in pediatric patients are mostly isolated from blood and mostly distribute in neonatalogy, gastroentero

关 键 词：表皮葡萄球菌 耐药性 MECA基因 icaA D基因 儿科 

分 类 号：R378[医药卫生—病原生物学]