成人和儿童金黄色葡萄球菌感染分子流行病学研究  

Molecular epidemiology research of Staphylococcus aureus infection from adult and child patients

作　　者：袁挺[1] 应春妹[2] 

机构地区：[1]上海交通大学医学院附属仁济医院检验科,上海200127 [2]上海复旦大学医学院附属妇产科医院检验科,上海200011

出　　处：《检验医学》2015年第11期1119-1124,共6页Laboratory Medicine

摘　　要：目的研究上海交通大学医学院附属仁济医院(简称上海仁济医院)及上海儿童医学中心分离的金黄色葡萄球菌(简称金葡菌)的分子流行病学特征及药物敏感性状况,为临床合理用药提供依据。方法收集2012年上海仁济医院分离的313株金葡菌和上海儿童医学中心分离的153株金葡菌,采用多位点序列分型(MLST)、葡萄球菌蛋白A spa基因分型和葡萄球菌染色体mec基因(SCCmec)分型技术进行分子生物学分型,对其中的耐甲氧西林金葡菌(MRSA)进行SCCmec分型;采用纸片扩散法对金葡菌进行药物敏感性分析。结果2012年上海仁济医院313株金葡菌有42.49%来自痰样本,其中MRSA 173株,检出率为55.27%;MLST结果MRSA以ST5型为主;spa基因分型结果以t002型最多,为90株,占MRSA的52.02%,其次为t030型(42株,24.28%);SCCmec分型结果以Ⅱ型为主。上海儿童医学中心153株金葡菌有62.09%来自痰样本,其中MRSA33株,检出率为21.57%;MLST结果 MRSA以ST59型为主;spa基因分型结果以t437型最多,为14株,占MRSA的42.42%,其次为t002型(5株,15.15%)及t316型(4株,12.12%);SCCmec分型结果以Ⅳ型为主。药物敏感性试验结果显示上海仁济医院和上海儿童医学中心金葡菌对万古霉素、去甲万古霉素、替考拉宁、利奈唑胺及替加环素5种抗菌药物100%敏感,对其他抗菌药物耐药率比较高。上海儿童医学中心MRSA对环丙沙星、莫西沙星、左氧氟沙星、克林霉素、利福平、庆大霉素的敏感性均明显高于仁济医院MRSA(P<0.01),对头孢唑啉及红霉素的敏感性差异无统计学意义(P>0.01)。结论 2012年上海仁济医院MRSA以ST5-t002-Ⅱ为主,上海儿童医学中心MRSA以ST59-t437-Ⅳ为主。相比于甲氧西林敏感金葡菌(MSSA),MRSA的克隆型别相对集中,更容易引起医院内的传播。MRSA在金葡菌中的分离率较高,临床应根据药物敏感性试验结果合理使用抗菌药物。Objective To investigate the molecular epidemiology characteristic and antimicrobial susceptibility of Staphylococcus aureus （S. aureus ） isolated from Renji Hospital affiliated to Shanghai Jiaotong University School of Medicine （Shanghai Renji Hospital） and Shanghai Children＇s Medical Center in order to provide reference for the rational use of clinical medication. Methods In 2012, 313 S. aureus isolated from Shanghai Renji Hospital and 153 S. aareus isolated from Shanghai Children＇s Medical Center were collected and analyzed by muhilocus sequence typing （MLST） and Staphylococcus protein A spa gene typing. In addition, staphylococcal cassette chromosome mec（SCCmec） typing was performed for methicillin-resistant Staphylococcus aureus （MRSA）. Antimicrobial susceptibility test was detected by Kirby-Bauer method. Results There were 313 isolates of S. aureus isolated from Shanghai Renji Hospital in 2012, mainly isolated from sputum, accounting for 42.49%, 173 isolates were MRSA, and the detection rate was 55.27%. The predominant type of MLST was STS. The predominant type of spa gene typing was t002 （90 isolates, 52.02% ）, and next type was t030 （42 isolates, 24.28% ）. The predominant type of SCCmec typing was I. There were 153 isolates of S. aureus isolated from Shanghai Children＇s Medical Center, mainly isolated from sputum, accounting for 62.09%, 33 isolates were identified as MRSA, and the detection rate was 21.57%. The predominant type of MLST was ST59. The predominant type of spa gene typing was t437（ 14 isolates, 42.42% ）, and next type was t002（5 isolates, 15. 15%） and t316（4 isolates, 12. 12%）. The predominant type of SCCmec typing was IV. The antimicrobial susceptibility test showed that all the S. aureu~ isolates were 100% sensitive to vancomycin, norvancomycin, teicoplanin, linezolid and tetracycline, and drug resistance rate was obviously lower than others. The drug resistance rates of MRSA from Shanghai Children＇s Medical Center to ciprofloxacin, moxifloxac

关 键 词：金黄色葡萄球菌 耐甲氧西林金黄色葡萄球菌 药物敏感性试验 分子生物学分型 流行病学分析 

分 类 号：R378.1[医药卫生—病原生物学]