中山地区耐甲氧西林金黄色葡萄球菌的耐药性分析及基因分型研究  

Drug resistance and SCCmec genotype of meticillin-resistant staphylococcus aureus in Zhongshan City

作　　者：林颜玉 陈文伟 王柏旺 卢玉平 

机构地区：[1]中山市古镇人民院检验科,广东中山528421

出　　处：《现代预防医学》2016年第19期3571-3575,共5页Modern Preventive Medicine

基　　金：中山市科技计划项目;项目编号:2014A1FC058

摘　　要：目的了解中山地区耐甲氧西林金黄色葡萄球菌(MRSA)临床分离株耐药性及基因型,为MRSA治疗及感染控制提供数据及分子生物学支持。方法收集2015年1月至2015年10月中山市7家医院临床分离到的MRSA,采用WOHONET 5.6对耐药数据进行统计分析,PCR检测MRSA耐药基因mec A携带情况,采用多重PCR对分离株进行葡萄球菌染色体mec基因盒(SCCmec)分型。结果 2015年1月至2015年10月7家医院共分离到50株MRSA,所有MRSA分离株均检出mec A基因,检出率为100%。SCCmec各分型数量依次为I型1株(2%),II型2株(4%),III型28株(56%),IV型6株(12%),V型12株(24%),有1株不能分型。中山市古镇人民医院分离MRSA株主要为SCCmec III型,其他6家医院主要为SCCmec IV型及V型。MRSA对青霉素耐药率为100%,对红霉素(90%)、庆大霉素(86%)、左氧氟沙星(84%)、诺氟沙星(84%)、克林霉素(76%)耐药率较高,对奎奴普丁/达福普丁(4%)耐药率较低,未检出替考拉宁及万古霉素耐药株。SCCmec III型菌株对庆大霉素、利福平、左氧氟沙星、诺氟沙星、复方新诺明、克林霉素、红霉素、奎奴普丁/达福普丁及四环素耐药率高于SCCmec V型菌株。结论 mec A是MRSA携带最常见的耐药基因,中山地区分离MRSA株在规模较大的医院主要以SCCmec III型为主,基层医院以SCCmec IV及V型为主,SCCmec III型对常用抗菌药敏感性较差,耐药机制较为复杂,临床科室及医院感染控制部门应重点监控该型细菌,避免院内感染暴发。Objective To investigate drug resistance and SCCmec genotype of Meticillin - resistant Staphylococcus aureus （MRSA） in Zhongshan city and to provide data and molecular biology evidence for infection therapy and nosocomial infection control. Methods MRSA were collected from 7 hospitals in Zhongshan,from January 2015 to October 2015. The data of drug resistance was analyzed by WHONET 5.6 software. PCR was used to test if the resistance gene was mecA,and multiplex PCR was used to analyze the genotype of SCCmec. Results 50 strains of MRSA were isolated from 7 hospitals in January 2015 to October 2015 ,all of which were detected carrying the gene of mecA. The number of each genotype of SCCmec were I 1 strain （2%）,II2 strains （4%）,III 28 strains （56%）,IV 6 strains （12%）,V 12 strains （24%） and 1 strains could not be classified. SCCmec III was the main genotype of MRSA isolated from Zhongshan Guzhen people＇s hospital. SCCmec IV and V were the main genotypes of the other 6 hospitals. The drug resistance rates of MRSA to penicillin, erythromycin,gentamicin, levofloxacin, norfloxacin, clindamycin and quinupristin/dalfopristin were 100% , 90% , 86% , 84% , 84% , 76% and 4% , respectively. No strain was resistant to teicoplanin and vancomycin. Drug -resistance rates to gentamicin, rifampicin, levofloxacin, norfloxacin, trimethoprim - sulfamethoxazole, clindamycin, erythromycin, quinupristin/dalfopristin and tetracycline of SCCmec III were significantly higher than SCCmec V. Conclusion The major drug - resistance gene of MRSA is mecA. SCCmec III is＇the major genotype of clinical isolated MRSA in large hospitals,Zhongshan City. SCCmec IV and V are major genotypes in a community hospital. SCCmec III has low sensitivity to commonly used antimicrobial agents and complex drug - resistance mechanism. Clinical and nosocomial infection control departments should focus on the genotype of SCCmec III to avoid the outbreak of nosocomial infection.

关 键 词：耐甲氧西林金黄色葡萄球菌 MECA基因 SCCmec分型 耐药性 

分 类 号：R117[医药卫生—公共卫生与预防医学]