儿童社区获得性耐甲氧西林金黄色葡萄球菌肺炎分离株的多重耐药克隆研究  

Multidrug-resistant clones of methicillin-resistant Staphylococcus aureus isolated from Chinese children with community-associated pneumonia

作　　者：李娟[1] 王群[2] 王丽娟[1] 孙明姣[1] 李士朋[1] 孙静[1] 王传清[3] 邓秋莲[4] 郑跃杰[5] 刘岚[6] 李昌崇[7] 尚云晓[8] 赵长安 杨永弘[1] 沈叙庄[1] 

机构地区：[1]首都医科大学附属北京儿童医院北京市儿科研究所儿科学国家重点学科教育部儿科重大疾病研究重点实验室,北京100045 [2]桂林医学院附属医院 [3]复旦大学附属儿科医院 [4]广州市儿童医院 [5]深圳市儿童医院 [6]重庆医科大学附属儿童医院 [7]温州医学院附属医院 [8]沈阳盛京医院 [9]广州妇幼保健院

出　　处：《中国感染与化疗杂志》2014年第1期32-37,共6页Chinese Journal of Infection and Chemotherapy

基　　金：国家自然科学基金国际(地区)合作与交流项目(81061160509);国家自然科学基金面上项目(81171648)

摘　　要：目的研究中国儿童社区获得性耐甲氧西林金葡菌（CA—MRSA）肺炎分离株的多重耐药情况与克隆之间的关系。方法2006--2012年收集85株CA—MRSA分离株和50株医院获得性MRSA（HA-MRSA）分离株，进行多位点序列分型（MLST）和16种抗菌药物药敏试验，用脉冲场凝胶电脉（PFGE）和Southern印迹杂交定位莫匹罗星耐药基因mupA。结果CA—MRSA和HA—MRSA对红霉素和克林霉素的耐药率较高，CA—MRSA对庆大霉素、四环素和利福平的耐药率低于HA-MRSA（分别为36．5％和60．0％，P〈0．01；34．1％和54．0％，P〈0．05；8．2％和48．0％，P〈0．01），对头孢呋辛、氯霉素和红霉素的耐药率高于HA—MRSA（100％和72．0％，P〈0．01；22．3％和2．0％，P〈0．01；87．0％和72．0％，P〈0．05）。CA-MRSA多重耐药率明显低于HA-MRSA。CA-MRSA多重耐药表型呈多样化，4种克隆（ST59、ST88、ST965和ST45）的多重耐药率高于50．0％。CA—MRSA中，1株对夫西地酸耐药，5株对莫匹罗星耐药，高水平莫匹罗星耐药基因mupA位于23～54．2kb的质粒上。结论儿童CA-MRSA分离株对非β内酰胺类抗菌药物有较高的耐药率，并且多重耐药率和耐药谱与菌株克隆有关。Objective To study the correlation between mul-tidrug resistance（MDR） and sequence type （ST） clones of community-associated methicillin-resistant Staphylococcus aureus （CA-MRSA） isolated from Chinese children with community-associated pneumonia and identify the gene re-sponsible for mupirocin resistance. Methods A total of 135 MRSA isolates were collected {rom eight hospitals, including 85 CA-MRSA and 50 hospital-associated methicillin-resistant Staphylococcus aureus （ HA-MRSA ） . Multilocus sequence typing（MLST） and antimicrobial susceptibility were analysized for all the strains. The gene conferring muprocin resistance was located by PFGE and Southern blot. Results Both CA-MRSA and HA-MRSA strains showed high resistance rates to clindamy-cin and erythromycin. Compared with H A-MRSA, the CA-MRSA strains showed higher resistance rates to cefuroxime （100% vs 72.0% ,P〈0. 01 ）, chloramphenicol 22.3% vs 2.0% ,P〈0. 01 and erythromycin （87.0% vs 72.00%, P〈0. 05）, but lower resitance rates to gentamicin （36.5% vs 60. 0%, P〈0.01）, tetracycline （34.1% vs 54.0%, P〈0.05） and rifampicin （8.2% vs 48.0%, P〈0.01 ）. The prevalence of MDR strains （resistance to three or more non-beta-lactams）in CA-MRSA was signifi- cantly lower than in HA-MRSA. Various MLST clones were identified in CA-MRSA. Higher prevalence of MDR （50.0% or higher） was found in 4 of the ST clones, namely ST59 （57.1%）, ST88 （50.0%）, ST965 （66.7 %） and ST45 （100%）. One MRSA strain was resistant to fusidic acid and 5 strains were resistant to mupiroein. The mupA gene conferring high-level re-sistance to mupirocin was located in the plasmid of 23-54.2 kb, which was confirmed by PFGE and Southern blot analysis. Conclusions The resistance to non beta-lactams, especially clindamycin and erythromycin, is highly prevalent in the CA MRSA strains isolated from Chinese children with community-associated pneumonia. In addition, the incidence and profile of antibiotic resistance is related to the cl

关 键 词：儿童 社区获得性肺炎 耐甲氧西林金黄色葡萄球菌 多位点序列分型 多重耐药 

分 类 号：R725.6[医药卫生—儿科]