我国苯唑西林敏感mecA阳性的金黄色葡萄球菌回顾性研究  

The retrospective study of oxacillin susceptible, mecA positive Staphylococcus aureus in China

作　　者：贺文强[1] 陈宏斌[1] 赵春江[1] 张菲菲[1] 王辉[1] 

机构地区：[1]北京大学人民医院检验科,100044

出　　处：《中华检验医学杂志》2014年第1期27-31,共5页Chinese Journal of Laboratory Medicine

基　　金：基金项目：国家自然科学基金资助课题（30971571）;新世纪优秀人才支持计划资助课题（NCET-10-0205）

摘　　要：目的研究苯唑西林敏感mecA阳性的金黄色葡萄球菌在我国的流行、分布及分子生物学特点。方法回顾性研究。采用琼脂稀释法对2010至2012年我国10个城市12所教学医院收集的1588株金黄色葡萄球菌进行20种抗生素药物敏感性检测。对苯唑西林敏感而头孢西丁耐药的金黄色葡萄球菌，进一步比较头孢西丁纸片扩散法、头孢西丁琼脂稀释法和苯唑西林琼脂稀释法的耐药结果。PCR法检测金黄色葡萄球菌特异基因nuc、femB及mecA，并进行分子分型，包括spa分型和SCCmec分型。使用SPSS18．0进行统计分析，以P≤0．05为差异有统计学意义。结果根据头孢西丁和苯唑西林MIC水平，鉴定出60株苯唑西林敏感的耐甲氧西林金黄色葡萄球菌（MRSA）。2010至2012年苯唑西林敏感MRSA在我国逐渐升高（P=0．05，95％C10．045—0．056，x2=6．099）。这些菌株主要分布在我国9个城市，其中广州分离率最高，占30．0％（18／60），其余依次为北京（18．3％，11／60），武汉（15．0％，9／60）和杭州（13．3％，8／60）。这60株菌最常见于皮肤软组织感染标本（35％，21／60），其次为血标本（30％，18／60）和呼吸道标本（18．3％，11／60）。药物敏感性分析显示，这些菌株对头孢西丁、红霉素、克林霉素和四环素耐药率分别为100％（60／60）、86．7％（52／60）、66．7％（40／60）和50％（30／60）。根据分子分型结果显示，共有21种spa分型、5种SCCmec分型，spat437-SCCmecIV最常见，占25．0％（15／60），其次为spat437-SCCmecV，占13．3％（8／60）。结论2010至2012年苯唑西林敏感MRSA在我国9个城市均有检出，并且检出率呈升高趋势。这种菌株主要是spa437．SCCmecIV型。应当用头孢西丁代替苯唑西林检测这种类型的MRSA。mecA阳性而苯唑西林敏感的金黄色葡萄球菌是否能够用B内酰胺类进行治疗，尚需要进一步研究�Objective The purpose of the study is to understand the epidemiology, distribution and molecular characteristics of oxacillin susceptible meeA positive Staphylococcus aureus （S. aureus）. Methods Totally 1588 S. aureus isolates collected from 12 hospitals in 10 cities of China between 2010 and 2012 were retrospectively characterized. The isolates were characterized by antimicrobial susceptibility test of 20 antimicrobial drugs. Three different methods （eefoxitin disc diffusion, agar dilution for oxacillin and cefoxitin） to detect oxaeillin susceptible and meeA positive S. aureus were also compared. All the strains were confirmed to be S. aureus by detecting S. aureus specific genes by PCR （including nuc, femB, and meeA gene）, which was viewed as the golden standard of MRSA. The molecular typing methods included SCCmec and spa typing. The statistical analyses were carried out in statistical product and service solutions （ SPSS）, Version 18. 0. The significance level P was set at 0. 05. Results According to the MICs of cefoxitin and oxacillin, a total of 60 isolates were oxacillin susceptible methicilin resistance Staphylococcus aureus （MRSA）. Based on the differences of the specimen collection date, it is found that oxacillin susceptible MRSA have increased from 2010 to 2012 （ P = 0. 05, 95% CI 0. 045 - 0. 056, X2 = 6. 099 ）.These isolates were distributed in 9 major cities, and the highest prevalence is 30. 0% （18/60） in Guangzhou, followed by Beijing （ 18. 3%, 11/60） ,Wuhan （ 15.0%, 9/60）, Hangzhou （ 13.3%, 8/60）. Most of the isolates were from skin soft tissue infection （35%, 21/60） , blood stream infection （30%, 18/ 60） and respiratory infection specimens （18. 3%, 11/60）. The resistance rate to cefoxitin, erythromycin, clindamycin and tetracycline was 100% （ 60/60）, 86. 7% （52/60）, 66. 7% （40/60） and 50% （ 30/60）, respectively. The molecular characterization showed that 21 spa and 5 SCCmec types were detected. The most predominant clone was spa

关 键 词：葡萄球菌 金黄色 苯唑西林 头孢西丁 抗药性 细菌 细菌分型技术 

分 类 号：R446.5[医药卫生—诊断学]