临床分离金黄色葡萄球菌的耐药特点和MRSA分子分型  

Antimicrobial resistance features and molecular typing of clinically isolated methicillin-resistant Staphylococcus aureus

作　　者：贾珉[1] 江元山[2] 朱建华[1] 高嘉嘉 王永涛[1] 胡志敏[1] 刘志钢 JIA Min;JIANG Yuan-shan;ZHU Jian-hua;GAO Jia-jia;WANG Yong-tao;HU Zhi-min;LIU Zhi-gang(Wuhan First Hospital,Wuhan 430022,China;Wuhan Center for Disease Control and Prevention,Wuhan 430015,China)

机构地区：[1]武汉市第一医院,湖北武汉430022 [2]武汉市疾病预防控制中心,湖北武汉430015

出　　处：《中国感染控制杂志》2018年第4期289-293,共5页Chinese Journal of Infection Control

基　　金：武汉市卫生和计划生育委员会科研项目(WG16B09)

摘　　要：目的研究耐甲氧西林金黄色葡萄球菌(MRSA)的耐药性及其基因分型。方法收集某院2014年1月—2015年11月检出的非重复金黄色葡萄球菌967株,检测其药敏结果及mecA抗性基因、杀白细胞素(PVL)基因;MRSA菌株经多重PCR进行葡萄球菌盒式染色体mec(SCCmec)分型、多位点序列分型(MLST)、金黄色葡萄球菌蛋白A基因(spa)分型、金黄色葡萄球菌附属因子调节子(agr)分型。结果 967株金黄色葡萄球菌共检出210株MRSA,MRSA检出率为21.72%;痰标本MRSA检出率高于皮肤软组织标本(68.09%vs 11.83%,P<0.05);金黄色葡萄球菌中未发现对万古霉素和利奈唑胺耐药菌株,MRSA对庆大霉素、四环素、红霉素、克林霉素、左氧氟沙星、环丙沙星、莫西沙星、呋喃妥因、利福平的敏感率均低于MSSA,差异均有统计学意义(均P<0.05);MRSA对复方磺胺甲口恶唑的敏感率高于MSSA,差异有统计学意义(P<0.05)。皮肤软组织分离的MRSA对庆大霉素、左氧氟沙星、环丙沙星、莫西沙星、利福平的敏感率为86.90%~95.24%,而痰分离的MRSA仅为1.56%~15.63%。967株金黄色葡萄球菌检测出210株携带mecA基因,10株携带PVL基因,210株MRSA中有8株未分型,占3.81%。MLST主要以ST239(177株)为主;SCCmec分型主要以Ⅲ型(177株)为主;spa分型主要以t 030(177株)为主;agr分型主要以Ⅰ型(196株)为主。结论该院MRSA菌株主要流行克隆ST239-MRSA-SCCmecⅢ-t030,耐药形势严峻,应加强医院内耐药菌株的监测。Objective To study antimicrobial resistance and genotyping of methicillin-resistant Staphylococcus aureus(MRSA).Methods A total of 967 no-repetitive strains of Staphylococcus aureus(S.aureus)isolated from a hospital between January 2014 and November 2015 were collected,antimicrobial susceptibility testing,mec A gene,and Panton-Valentine leukocidin gene(PVL gene)were detected;staphylococcal cassette chromosome mec(SCC mec)typing,multilocus sequence typing(MLST),S.aureus protein A(spa)gene typing,and S.aureus accessory gene regulator(agr)typing were performed with multiplex polymerase chain reaction.Results Of 967 strains of S.aureus,210(21.72%)were MRSA;detection rate of MRSA from sputum specimen was higher than that of skin and soft tissue specimen(68.09%vs 11.83%,P<0.05);vancomycin-and linezolid-resistant S.aureus strains were not found,susceptibility rates of MRSA to gentamicin,tetracycline,erythromycin,clindamycin,levofloxacin,ciprofloxacin,moxifloxacin,nitrofurantoin,and rifampicin were all lower than those of methicillin-sensitive Staphylococcus aureus(MSSA),differences were all statistically significant(all P<0.05);antimicrobial susceptibility rate of MRSA to compound sulfamethoxazole was higher than MSSA,difference was significant(P<0.05).Susceptibility rates of MRSA isolated from skin and soft tissue to gentamicin,levofloxacin,ciprofloxacin,moxifloxacin,and rifampicin were 86.90%-95.24%,while MRSA isolated from sputum were only 1.56%-15.63%.Of 967 strains of S.aureus,210 harbored mec A gene,10 harbored PVL gene,8(3.81%)of 210 MRSA strains weren’t typed.The main types of MLST,SCCmec,spa,and agr were ST 239(n=177 strains),typeⅢ(n=177 strains),t 030(n=177 strains),and typeⅠ(n=196 strains)respectively.Conclusion The main epidemic clone of MRSA strain in this hospital is ST239-MRSA-SCCmec III-t030,antimicrobial resistance is serious,monitoring on drug-resistant strains in hospital should be strengthened.

关 键 词：耐甲氧西林金黄色葡萄球菌 分子流行病学 SCC mec基因分型 PVL基因 

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]