ICU患者分离金黄色葡萄球菌的耐药性及分子流行病学特征  

Characteristics of antimicrobial resistance and molecular epidemiology of Staphylococcus aureus isolated from patients in intensive care units

作　　者：徐修礼[1] 周珊[1] 白露[1] 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

出　　处：《中国感染控制杂志》2016年第5期294-298,共5页Chinese Journal of Infection Control

基　　金：陕西省自然科学基金资助项目(2014JM4188)

摘　　要：目的了解某院重症监护病房(ICU)金黄色葡萄球菌的耐药特点及分子流行病学特征。方法收集2014年1—12月该院ICU分离的金黄色葡萄球菌,进行细菌鉴定及药物敏感性试验,采用金黄色葡萄球菌A蛋白(spa)分型及多位点序列分型(MLST)方法进行分型。结果 160株金黄色葡萄球菌中耐甲氧西林金黄色葡萄球菌(MRSA)120株(占75.00%)。MRSA对红霉素、克林霉素、左氧氟沙星的耐药率均>80%;MSSA对头孢唑林敏感,对红霉素、克林霉素、左氧氟沙星的耐药率分别为62.50%、35.00%、10.00%。spa分型和MLST结果显示,120株MRSA主要为ST239-t030、ST239-t037、ST5-t2460 3种型别,其中ST239-t030(105株,87.50%)为主要流行菌株,8个ICU均有检出;MSSA存在较多型别,ST59-t437仅在神经内科(8株)和消化科(2株)检出,ST6-t701、ST398-t3625、ST398-t1793和ST121-t2092分别仅在神经内科(7株)、麻醉科(5株)、神经外科(4株)和心外科(4株)检出。结论该院ICU MRSA分离率较高,以ST239-t030克隆株为主,存在医院内流行;不同型别MSSA在各科室内存在流行趋势。Objective To study the characteristics of antimicrobial resistance and molecular epidemiology of Staphylococcus aureus（S.aureus）in the intensive care units（ICUs）of a hospital.Methods Clinical isolates of S.aureus collected from ICUs between January and December 2014 were identified and performed antimicrobial susceptibility testing,then typed by staphylococcal protein A（spa）typing and multilocus sequence typing（MLST）methods.Results Of 160 isolates of S.aureus,120（75.00%）were methicillin-resistant S.aureus（MRSA）.Resistance rates of MRSA to erythromycin,clindamycin,and levofloxacin were all 80%;methicillin-sensitive S.aureus（MSSA）were sensitive to cefazolin,resistance rates to erythromycin,clindamycin,and levofloxacin were62.50%,35.00%,and 10.00% respectively.spa typing and MLST results showed that the main types of 120 isolates of MRSA were ST239-t030,ST239-t037,and ST5-t2460,the major epidemic strains were ST239-t030（n=105,87.50%）,and were isolated from8 ICUs;MSSA had more types,ST59-t437 were detected only from department of neurology（n=8）and department of digestive diseases（n=2）,ST6-t701,ST398-t3625,ST398-t1793,and ST121-t2092 were isolated from departments of neurology（n=7）,anesthesiology（n=5）,neurosurgery（n=4）,and cardiac surgery（n=4）respectively.Conclusion Isolation rate of MRSA in ICUs in this hospital is high,ST239-t030 is the main type,which prevailed in hospital;different types of MSSA have epidemic trends in various departments.

关 键 词：重症监护病房 金黄色葡萄球菌 spa分型 MLST 流行病学 抗药性 微生物 耐药性 

分 类 号：R181.32[医药卫生—流行病学]