儿童耐甲氧西林金黄色葡萄球菌的耐药性和耐药基因研究  

Study on antibiotic resistance and resistance genes of methicillin-resistant Staphylococcus aureus in children

作　　者：吴霞[1] 王传清[1] 严秀峰[1] 王爱敏[1] 何磊燕[1] 糜祖煌[1] 俞蕙[1] 

机构地区：[1]复旦大学附属儿科医院感染科,上海201102

出　　处：《中华传染病杂志》2013年第11期641-645,共5页Chinese Journal of Infectious Diseases

摘　　要：目的 了解儿童临床分离的耐甲氧西林金黄色葡萄球菌（MRSA）耐药基因携带及其对抗菌药物耐药的状况.方法 收集复旦大学附属儿科医院2009年3月至2011年11月因感染性疾病住院患儿中采集标本分离的MRSA株.PCR法检测mecA、ermA、ermB、ermC、aac（6＇）/aph（2＂）、aph（3＇）-Ⅲ、ant（4＇,4＂）和qacA基因,纸片扩散法检测MRSA对常用抗菌药物的耐药性.数据统计采用卡方检验.结果 37株MRSA中,mecA基因均阳性;ermB阳性9株,占24.3％,而ermA、ermC均为阴性;aac（6’）/aph（2＂）阳性21株,占56.8％;aph（3＇）-Ⅲ阳性10株,占27.0％;ant（4＇,4＂）阳性6株,占16.2％;qacA阳性9株,占24.3％.医院获得性MRSA（HA-MRSA）中aac（6’）/aph（2＂）的检出率为85.7％,明显高于社区获得性MRSA （CA-MRSA）的18.8％（x2 =60.340,P=0.000）.37株MRSA对青霉素、氨苄西林/舒巴坦、头孢唑啉、头孢西丁、头孢呋辛耐药率均为100.0％,对替考拉宁、万古霉素、利奈唑胺均敏感.CA-MRSA和HA-MRSA对庆大霉素（12.5％比81.0％,x2=17.033,P=0.000）,左氧氟沙星（31.2％比71.4％,x2=5.903,P=0.017）,利福平（6.2％比61.9％,x2=11.959,P=0.001）的耐药率比较,差异均有统计学意义.携带aac（6＇）/aph（2＂）株对庆大霉素的耐药率明显高于未携带株,差异有统计学意义（x2=29.757,P=0.000）.结论 儿童临床分离的MRSA携带多种耐药基因,表现出多重耐药性.HA-MRSA与CA-MRSA相比,其对抗菌药物耐药率和耐药基因携带率更高.Objective The aim of this study was to study the antibiotic resistance and resistance genes of methicillin-resistant Staphylococcus aureus （MRSA） in children from Shanghai area,and to determine the relationship between phenotypic and genotypic resistance profiles.Methods In this study,a total of 37 MRSA strains isolated from clinical specimens of hospitalized patients in Children＇s Hospital of Fudan University from March 2009 to November 2011 were collected.The mecA,ermA,ermB,ermC,aac （6＇） /aph （2＂）,aph （3＇）-Ⅲ,ant （4＇,4＂）,and qacA genes were detected by polymerase chain reaction （PCR）.Resistance to antibiotics was detected by agar dilution tests.The data analysis was done by chi square test.Results Among the 37 MRSA isolates,all （100.0 %） were mecA gene positive,9 （24.3%） were ermB gene positive,none was ermA/C gene positive,21 （56.8%） were aac （6＇）/aph （2＂） gene positive,10 （27.0%） were aph （3＇）-Ⅲ gene positive,6 （16.2%） were ant（4＇,4＂） gene positive,and 9 were qacA gene positive （24.3%）.The positive rate of aac（6＇）/aph（2＂） in hospital acquired methicillin-resistant Staphylococcus aureus （HA-MRSA） was significantly higher than that of community acquired methicillin-resistant Staphylococcus aureus （CA-MRSA） （85.7% vs18.8%,x2=60.340,P=0.000）.Among the 37 MRSAisolates,37 （100.0%） were resistant to penicillin,ampicillin-sulbactam,cefazolin,cefoxitin and cefuroxime.The 37 isolates were all susceptible to teicoplanin,vancomycin,and linezolid.The resistant rates to gentamicin,erythromycin,clindamycin,sulfamethoxazole,fosfomycin,rifampicin,and levofloxacin were 51.4% （19/37）,81.1% （30/37）,51.4% （19/37）,16.2% （6/37）,27.0% （10/37）,37.8% （14/37） and 54.0% （20/37）,respectively.Compared with CA-MRSA,HAMRSA isolates had significantly higher resistance rates to gentamicin （12.5% vs 81.0%; x2 =17.033,P=0.000）,levofloxacin （31.2% vs 71.4%; x2 =5.903,P=0.017）,and rifampin （6.2

关 键 词：甲氧西林抗药性 葡萄球菌 金黄色 药物耐受性 基因 抗药性 多药 儿童 

分 类 号：R440[医药卫生—诊断学]