鼻拭子中异质性万古霉素中介的金黄色葡萄球菌的流行情况  

The Prevalence of Heterogeneous Vancomycin-intermediate Resistant Staphylococcus Aureus in Nasal Swab Specimens

作　　者：王兵 杨靖娴[1] 邵冬华[1] 梁国威[1] WANG Bing;YANG Jing-xian;SHAO Dong-hua;LIANG Guo-wei(Department of Clinical Laboratory,Aerospace Center Hospital,Beijing 100049,China)

机构地区：[1]航天中心医院检验科

出　　处：《标记免疫分析与临床》2019年第9期1537-1541,共5页Labeled Immunoassays and Clinical Medicine

基　　金：首都卫生发展科研专项青年课题(编号:首发2014-4-6081);航天中心医院院级基金课题(编号:YN201503)

摘　　要：目的了解我院住院患者鼻腔拭子中异质性万古霉素中介的金黄色葡萄球菌(hVISA)的发生率。方法收集临床57例来自鼻拭子的金黄色葡萄球菌标本,分别采用浓度为2mg/L和4mg/L万古霉素脑心浸液琼脂平皿(BHIA2V、BHIA4V)、浓度为5mg/L替考拉宁脑心浸液琼脂平皿(BHIA5T)和宏量E-test法(MET)进行hVISA筛选,同时应用改良菌群分析-曲线下面积(PAP-AUC)作为hVISA检测的金标准进行确证,从而确定我院hVISA的发生率。结果BHIA2V、BHIA4V和BHIA5T筛选阳性菌株分别为33、0和5株,MET方法阳性菌株数为0,PAP-AUC确证hVISA菌株数为0,因此我院鼻拭子中未分离出hVISA。结论BHIA2V筛选方法假阳性数太高,不适合用于临床hVISA初筛;MET的价格比较高,不适合常规开展;因此我们建议将BHIA4V和BHIA5T作为临床上hVISA的常规筛选方法,筛选阳性结果通过MET方法进行验证,最后通过PAP-AUC确证。虽然从我院鼻拭子中未检出hVISA,但是金黄色葡萄球菌的分离率是比较高的,尤其是ICU和呼吸科监护室的住院患者,这仍然需要引起临床高度重视,合理使用抗生素尤其是糖肽类药物,避免hVISA和VISA的发生。Objective To investigate the prevalence of heterogeneous vancomycin-intermediate resistant Staphylococcus aureus(hVISA)in nasal swabs in our hospital.Methods A total of 57 Staphylococcus aureus strains were isolated for the study.All the strains were screened by 2mg/L and 4mg/L vancomycin brain-heart infusion agar(BHIA2V,BHIA4V),5mg/L teicoplanin brain heart infusion agar(BHIA5T),as well as macroEtest method(MET)for hVISA.The modified population analysis profile-area under the curve(PAP-AUC)method was taken as the gold standard to report the incidence of hVISA.Results BHIA2V,BHIA4V,BHIA5T and MET screening methods identified 33,0,5,0 strains,respectively.The number of strains confirmed by PAP-AUC was 0.Therefore,hVISA was not isolated from nasal swabs in our hospital.Conclusion Our results suggest that BHIA4V and BHIA5T can be used as a routine hVISA screening method,and the screening positive strains will be further tested by MET method.At last,possible hVISA isolates will be confirmed by PA-AUC.

关 键 词：金黄色葡萄球菌 异质性万古霉素中介的金黄色葡萄球菌 HVISA 筛选 鼻拭子 

分 类 号：R44[医药卫生—诊断学]