徐州地区116株MRSA耐药性分析与分子流行病学调查  

Antimicrobial resistance and molecular epidemiology of 116 strains of methicillin-resistant Staphylococcus aureuin Xuzhou area

作　　者：纵帅 徐萍萍[2] 顾兵 郝婷婷 寇艳波 徐银海 

机构地区：[1]徐州医科大学附属医院,江苏徐州221002 [2]徐州市中心医院,江苏徐州221002 [3]徐州医科大学感染与免疫实验室,江苏徐州221004

出　　处：《中国感染控制杂志》2017年第2期104-108,共5页Chinese Journal of Infection Control

基　　金：徐州市科技局资助项目(KC14SH116)

摘　　要：目的了解耐甲氧西林金黄色葡萄球菌(MRSA)感染现状和耐药机制,为临床合理用药提供依据。方法收集徐州地区2012—2015年各类标本中分离的金黄色葡萄球菌(SA),用头孢西丁纸片扩散法初筛MRSA菌株,扩增mecA基因进行确认,K-B法检测MRSA对药物的敏感性,E-test法测定万古霉素的最低抑菌浓度(MIC),采用多重PCR进行葡萄球菌染色体mec(SCCmec)基因分型。结果 2012—2015年210株SA共检出MRSA116株,其中mecA基因阳性114株,MRSA总检出率为55.24%。MRSA对万古霉素、奎奴普丁/达福普汀、替考拉宁和利奈唑胺的敏感率均为100%,对氯霉素和呋喃妥因的耐药率最低,分别为15.52%、1.72%,MRSA对10种抗菌药物的耐药率>80%;MRSA对青霉素类、氨基糖苷类、红霉素、喹诺酮类、磺胺类、利福平、四环素、克林霉素的耐药率高于甲氧西林敏感金黄色葡萄球菌(MSSA)。2012—2015年万古霉素对MRSA的MIC均为1.0μg/mL,MIC90均为1.5μg/mL,2015年发现1株MRSA的万古霉素MIC为2.0μg/mL。116株MRSA分型结果显示,SCCmecII型11株(9.48%),SCCmecIII型85株(73.28%),SCCmecIV型4株(IVa和IVb型各2株,均为1.72%),未分型MRSA16株(13.79%),未检出SCCmecI和V型。结论 MRSA呈严重的多重耐药,对万古霉素MIC无漂移,临床MRSA分离株以SCCmecIII型为主,临床应采取感染控制措施,控制MRSA感染。ObjectiveTo investigate infection status and antimicrobial resistance mechanism of methicillinresistant Staphylococcus aureus（MRSA）,and provide reference for the rational antimicrobial use in clinic. MethodsStaphylococcus aureus （SA） isolated from various specimens in Xuzhou area in 2012-2015 were collected, MRSA strains were preliminarily screened by cefoxitin disk diffusion method, and confirmed by amplification of mecA gene, antimicrobial resistance of MRSA was determined by KirbyBauer method, minimal inhibitory concentration （MIC） was measured by Etest method, genotypes of staphylococcal chromosomal cassette mec（SCCmec） were determined by multiplex PCR. ResultsA total of 116 strains of MRSA were identified among 210 SA strains in 2012-2015,114 of which were positive for mecA gene, the total detection rate of MRSA was 55.24%. Susceptibility rates of MRSA to vancomycin, quinupristin/ dalfopristin, and linezolid were all 100%, resistance rates of MRSA to chloramphenicol and furantoin were both low, which were 15.52% and 1.72% respectively, resistance rates of MRSA to 10 kinds of antimicrobial agents were all〉80%; resistance rates of MRSA to penicillins, aminoglycosides, macrolides, quinolones, sulfanilamide, rifampicin, tetracycline, and clindamycin were all higher than methicillinsensitive Staphylococcus aureus（MSSA）. MICs of vancomycin to MRSA in 2012-2015 were all 1.0 μg/mL,MIC90 were all 1.5 μg/mL, one MRSA isolate was with a vancomycin MIC of 2.0 μg/mL in 2015. MRSA typing results of 116 MRSA isolates showed that SCCmec II, SCCmec III, and SCCmec IV accounted for 9.48%（n=11）, 73.28%（n=85）,and 1.72%（Iva, n=2; IVb, n=2） respectively, 13.79%（n=16） of MRSA isolates were nontypeable, SCCmec I and SCCmec V type strains were not found. ConclusionMRSA is seriously multidrugresistant,the drift has not been discovered in MIC value of vancomycin against MRSA, the major SCCmec genotype of MRSA is SCCmec III, infection control measures should be taken to control M

关 键 词：耐甲氧西林金黄色葡萄球菌 MRSA 耐药性 最低抑菌浓度 MIC 葡萄球菌染色体mec盒 SCCMEC 

分 类 号：R181.32[医药卫生—流行病学] R378.11[医药卫生—公共卫生与预防医学]