血液和无菌体液分离金黄色葡萄球菌对抗菌药物的敏感性及毒力基因检测  

In vitro antimicrobial susceptibility and virulence genes of the Staphylococcus aureus strains isolated from blood and sterile body fluids

作　　者：郭燕[1] 吴湜[1] 傅祝英杰 杨洋[1] 胡付品[1] 朱德妹[1] 

机构地区：[1]复旦大学附属华山医院抗生素研究所,卫生部抗生素临床药理重点实验室,上海200040

出　　处：《中国感染与化疗杂志》2017年第2期127-133,共7页Chinese Journal of Infection and Chemotherapy

基　　金：国家科技部"重大新药创制"科技重大专项(2012ZX09303004-001)

摘　　要：目的了解1999-2014年复旦大学附属华山医院血液和脑脊液等无菌体液中分离的金黄色葡萄球菌(金葡菌)对临床常用抗菌药物的敏感性及其毒力基因检测。方法采用琼脂稀释法测定万古霉素等抗菌药物对临床分离金葡菌的最低抑菌浓度(MIC);采用聚合酶链反应(PCR)法检测MRSA的耐药基因mecA、mecC及其毒力基因PVL和sasX。结果258株金葡菌中MRSA菌株占54.3%(140/258),MSSA占45.7%(118/258),血液、脑脊液和胸腹水等无菌体液中MRSA的检出率由1999-2002年的71.9%逐年下降至2011-2014年的43.7%。药敏试验结果显示:MRSA对多数受试抗菌药物的耐药率均高于MSSA。MSSA对受试抗菌药仍然十分敏感,细菌耐药率除青霉素外,均≤11%。β内酰胺类(除青霉素外)对MSSA的MIC90值均≤1 mg/L。未发现对万古霉素、替考拉宁和利奈唑胺耐药株。90株临床分离的MRSA mecA基因阳性检出率为100%,未检测到mecC基因;sasX基因的阳性检出率为46.7%,未检测到PVL基因。sasX阳性的MRSA和sasX阴性的MRSA菌株对β内酰胺类抗生素、磷霉素和左氧氟沙星均高度耐药,但sasX阳性MRSA菌株对阿米卡星和甲氧苄啶-磺胺甲唑的耐药率均高于sasX阴性的MRSA菌株。结论 MRSA对临床多数抗菌药物耐药,为临床合理应用抗菌药物,应重视和加强对金葡菌中MRSA的监测。Objective To investigate the antimicrobial susceptibility and associated virulence genes of the Staphylococcus aureus strains isolated from blood, cerebrospinal fluid and other sterile body fluids in Huashan Hospital from year 1999 to 2014. Methods MIC values of vancomycin and other antibiotics against S. aureus were measured by agar dilution method. Resistant genes mecA and mecC and virulence genes PVL and sasX were detected by PCR in the S. aureus strains. Results The overall prevalence of MRSA in S. aureus was 54.3 % （140/258） and 45.7 % （118/258） for MSSA. Resistance rates of MRSA to most antimicrobial agents were higher than MSSA. MSSA strains were still sensitive to all the antibiotics tested, resistance rate not higher than 11% except penicillin. MIC90 values of β-1actam antibiotics （except penicillin） to MSSA were lower than 1 mg/L. Nostaphylococcal strains were found resistant to vancomycin, teicoplanin or linezolid. The mecA gene was present in all the 90 MRSA strains, and sasX gene in 46.7 % of the strains. The prevalence of MRSA isolated from blood, cerebrospinal fluid and other sterile body fluids decreased year by year. No mecC gene or PVL gene was identified in these MRSA strains. Both sasX-positive MRSA and sasX-negative MRSA were resistant to β-lactam antibiotics, fosfomycin and levofloxacin. The sasX-positive MRSA strains showed higher resistance rates to amikacin and trimethoprim-sulfamethoxazole than sasX-negative MRSA. Conclusions The MRSA strains isolated from blood, cerebrospinal fluid and other sterile body fluids in Huashan Hospital were resistant to most commonly used anbiotics. MRSA surveillance is critical for rational use of antimicrobial agents.

关 键 词：金黄色葡萄球菌 无菌体液 抗菌药物敏感性 

分 类 号：R440[医药卫生—诊断学]