金黄色葡萄球菌耐药性分布特征及分子流行病学研究  

Distribution characteristics and molecular epidemiology of resistance of Staphylococcus aureus

作　　者：丛萌倩 CONG Mengqian(Department of Clinical Laboratory,Affiliated Hospital of Qinghai University,Xining,Qinghai 810001,China)

机构地区：[1]青海大学附属医院检验科,青海西宁810001

出　　处：《国际检验医学杂志》2020年第11期1382-1386,共5页International Journal of Laboratory Medicine

摘　　要：目的了解该院微生物实验室临床送检样本分离的金黄色葡萄球菌(SA)中耐甲氧西林金黄色葡萄球菌(MRSA)的分布特点及耐药情况。检测杀白细胞素(pvl)基因携带情况,了解耐药菌株的流行趋势,为临床合理使用抗菌药物提供科学依据。方法回顾性分析该院2015年1月至2017年12月临床送检样本中SA的检出情况,采用纸片扩散法对SA分离株进行体外药敏试验检测,鉴定MRSA及对其他常见抗菌药物的耐药情况,采用聚合酶链式反应检测pvl基因携带情况。结果临床共分离到441株SA,2015-2017年的MRSA检出率分别为36.69%、32.89%、30.67%,其中406株SA来源于住院患者样本包括145株MRSA,35株SA来源于门诊患者样本包括2株MRSA。所有SA菌株对青霉素、红霉素、克林霉素、左氧氟沙星、阿莫西林、庆大霉素、头孢唑啉的耐药率均大于50.00%,其中大部分耐药株来源于住院患者样本,而对利福平和复方磺胺甲噁唑的耐药率则较低,分别为7.26%和12.02%,未发现对万古霉素有抗性的SA菌株。住院患者样本的耐药率显著高于门诊患者样本耐药率,门诊患者来源的SA菌株仅对青霉素有高耐药率(88.57%),对其他抗菌药则为中等或较低程度耐药。共检出28株SA携带pvl基因,携带率为6.35%,其中7株来源于门诊患者样本,携带率高于住院患者样本。pvl阴性菌株对复方磺胺甲噁唑的耐药性稍高,对其他检测抗菌药物的灵敏度没有影响。结论该院临床分离的SA菌株中MRSA检出率近3年未见明显变化,且pvl基因携带率较低,但对多种常见抗菌药物有较高耐药率,住院患者样本的MRSA检出率和耐药率均高于门诊患者,今后需要注意临床合理用药并加强对SA感染的耐药监测,以有效控制耐药株的产生和流行。Objective To investigate the distribution and drug resistance of methicillin-resistant Staphylococcus aureus(MRSA)in clinical samples of Staphylococcus aureus(SA).In order to understand the epidemic trend of drug-resistant strains and provide scientific basis for the rational use of antibiotics in clinical practice,we detected the gene carrying situation of Panton-Valentine leucocyte(pvl).Methods The detection of SA in clinical samples of the hospital from January 2015 to December 2017 was analyzed retrospectively.The paper diffusion method was used to detect the drug sensitivity of SA isolate in vitro,the resistance of MRSA and other common antibiotics were identified,and the pvl gene carrier was detected by PCR.Results A total of 441 strains of SA were isolated clinically,and the detection rates of MRSA in 2015-2017 were 36.69%,32.89%and 30.67%respectively.Among them,406 strains of SA were from inpatient samples,including 145 strains of MRSA,and 35 strains of SA were from outpatient samples,including 2 strains of MRSA.The resistance rates of all SA strains to penicillin,erythromycin,clindamycin,levofloxacin,amoxicillin,gentamycin and cefazolin were more than 50.00%.Most of the resistant strains were from inpatient samples,while the resistance rates to rifampicin and compound neoforman were low,7.26%and 12.02%respectively.No SA strains resistant to vancomycin were found.The drug resistance rate of inpatients was significantly higher than that of outpatients.The high drug resistance rate of SA strains from outpatients was 88.57%only to penicillin,and the resistance rate to other antibiotics was medium or low.A total of 28 strains of SA were detected to carry pvl gene(the carrying rate was 6.35%),7 of them were from outpatients,and the carrying rate was higher than that of inpatients.Pvl-strain had a slightly higher resistance to compound minophen and had no effect on the sensitivity of other antimicrobial agents.Conclusion In recent three years,the detection rate of MRSA in clinical isolated SA strains in hospita

关 键 词：金黄色葡萄球菌 耐甲氧西林 耐药性 杀白细胞素 

分 类 号：R446.5[医药卫生—诊断学]