社区获得性耐甲氧西林金黄色葡萄球菌SCCmec分型及耐药性研究  

Research on SCCmec typing and antimicrobial susceptibility of community-acquired methicillin-resistant Staphylococcus

作　　者：刘小丽[1] 王斌[1] 江元山[1] 梁建生[1] 袁红[2] 周燕飞 张丽华[4] 杨志兵 夏志忠 许慧琼[1] 

机构地区：[1]武汉市疾病预防控制中心,武汉430015 [2]武汉市第一医院,武汉430022 [3]武汉市第五医院,武汉430050 [4]黄陂区人民医院,武汉430300 [5]江汉区万松街社区卫生服务中心,武汉430022 [6]江岸区西马街社区卫生服务中心,武汉430015

出　　处：《中国抗生素杂志》2015年第3期197-202,共6页Chinese Journal of Antibiotics

基　　金：武汉市卫生局公共卫生科研项目(No.WG12D03)

摘　　要：目的探讨武汉地区社区获得性耐甲氧西林金黄色葡萄球菌(CA-MRSA)葡萄球菌盒染色体mec(SCCmec)基因型和耐药现状。方法采用前瞻性研究,选取武汉5所医疗机构门诊就诊的1400例皮肤软组织感染(SSTI)患者,采集病灶标本进行细菌培养。采用纸片扩散法对所有分离到的金黄色葡萄球菌进行药敏试验。应用多重PCR对CA-MRSA进行SCCmec分型。结果从1400例SSTI中共分离到203株金黄色葡萄球菌,分离率为14.50%(203/1400),其中有21株CA-MRSA,分离率为10.34%(21/203),SCCmec分型为10株SCCmecⅣ型、11株SCCmecⅤ型,SCCmecⅣ型有两种亚型(9株SCCmecⅣa、1株SCCmecⅣh)。药敏结果显示,CA-MRSA对红霉素敏感性低,为14.29%;对多西环素、复方磺胺甲噁唑敏感性较高,分别为95.24%、61.90%;有9.52%为多重耐药菌,均为SCCmecⅣ型;MSSA对大部分抗菌药物较敏感。结论 CA-MRSA在武汉地区SSTI患者中的分离率较低,对大多数非β-内酰胺类抗菌药物较为敏感,多重耐药率较低,经验治疗宜选择复方磺胺甲噁唑和多西环素。Objective To explore Staphylococcal cassette chromosome mec （SCCmec） typing and antimicrobial susceptibility of community-acquired methicillin-resistant （CA-MRSA） Staphylococcus in Wuhan. Methods 1,400 outpatients with skin and soft tissue infections （SSTI） were enrolled from 5 different hospitals in Wuhan prospectively. Antimicrobial susceptibility was performed for all S. aureus isolates by disk diffusion method. Genetypes of SCCmec were determined by multiplex PCR. Results S. aureus accounted for 14.50%（203/1400）, 21 isolates （21/203, 10.34%） were CA-MRSA. These CA-MRSA isolates harbored SCCmeclV（10）, SCCmec V （11）, SCCmeclV had two subtypes （9 SCCmec IVa, 1 SCCmec IVh）. CA-MRSA was lowly susceptible to erythromycin （14.29%）, but highly susceptible to doxycycline （95.24%） and trimethoprim/sulfamethoxazole （61.90%）. The prevalence of multidrug resistant strains was 9.52%, which was SCCmeclV. MSSA was susceptible to almost antibiotics. Conclusion The prevalence of CA-MRSA in SSTI of Wuhan was lower, which was highly susceptible to almost non-β-lactam antibiotics, lower multidrug resistant, doxycycline and trimethoprim/sulfamethoxazole are recommended for clinical treatment of CA-MRSA.

关 键 词：社区获得性耐甲氧西林金黄色葡萄球菌 皮肤软组织感染 葡萄球菌盒染色体 mec耐药性 

分 类 号：R378[医药卫生—病原生物学]