血流感染金黄色葡萄球菌克林霉素耐药与分子流行病学研究  

Study on clindamycin resistance and molecular epidemiology of bloodstream infection by Staphylococcus aureus

作　　者：周珊[1] 张蓓[2] 徐修礼[1] 冯琳涵 刘家云[1] 马越云[1] 郝晓柯[1] 

机构地区：[1]第四军医大学西京医院全军临床检验医学研究所,陕西西安710032 [2]西安交通大学附属西安市红十字会医院检验科,陕西西安710054

出　　处：《国际检验医学杂志》2015年第24期3517-3519,共3页International Journal of Laboratory Medicine

基　　金：陕西省自然科学基金资助项目(2014JM4188)

摘　　要：目的了解2014年全院血流感染金黄色葡萄球菌红霉素对克林霉素诱导耐药基因情况及分子流行病学分析。方法收集2014年全年临床血液标本分离的金黄色葡萄球菌。以双纸片法筛选红霉素对克林霉素诱导耐药的表型。erm基因检测采用PCR方法,并用spa及多位点序列分型(MLST)方法了解不同erm型分子流行情况。结果 33株金黄色葡萄球菌中MRSA分离率78.79%。且MRSA均携带有ermA基因。在7株甲氧西林敏感金黄色葡萄球菌(MSSA)中,4株分别携带ermB或ermC基因。spa及MLST结果显示,该院血流感染耐甲氧西林金黄色葡萄球菌(MRSA)以ST239-t030型别为主;而MSSA存在较多型别,如ST59-t437、ST398-t3625等。结论 MRSA有较高分离率,主要以ST239-t030克隆株为主。erm基因主要以ermA检出为主(86.67%)。菌株对抗菌药物耐药明显,实验室应加强对克林霉素诱导耐药的检测,以指导临床合理使用抗菌药物。Objective To understand the clindamycin resistance gene and molecular epidemic of Staphylococcus aureus in the patients with bloodstream infection in our hospital during 2014.Methods The clinical isolates of Staphylococcus aureus in clinical bloodstream infection were collected during 2014.The phenotype of erythromycin to clindamycin induced resistance was assessed by D test.The erm gene was detected by PCR.The different erm types of the molecular epidemiology of Staphylococcus aureus were studied by spa and MLST typing.Results In 33 strains of Staphylococcus aureus,the isolation rate of MRSA strains were78.79%,moreover all of MRSA strains carried ermA gene.In 7strains of methicillin sensitive Staphylococcus aureus（MSSA）,4strains respectively carried ermB or ermC gene.The results of MLST and spa results showed that the main type of MRSA in our hospital was ST239-t030.But MSSA had more types,such as ST59-t437,ST398-t3625 and so on.Conclusion MRSA has higher isolation rate in our hospital,which is dominated by ST239-t030 type.For the detection of gene erm,ermA（86.67%）is the main type.The strains are obviously resistant to antibacterial drugs.The laboratory should strengthen the detection of clindamycin induced resistance for guiding the clinical rational use of antibacterial drugs.

关 键 词：血流感染 金黄色葡萄球菌 erm基因 流行病学 耐药性 

分 类 号：R446.5[医药卫生—诊断学]