耐甲氧西林金黄色葡萄球菌院内感染分布及耐药机制研究  

Study on the distribution of nosocomial infections and drug resistance mechanisms of MRSA

作　　者：徐国超[1] 关若为 朱明武 曹献芹[1] 李冰[1] 郭珊[1] 朱晓燕 XU Guo-chao;GUAN Ruo-wei;ZHU Ming-wu;CAO Xian-qin;LI Bing;GUO Shan;ZHU Xiao-yan(Xinxiang Central Hospital,Xinxiang,Henan,China 453000;Xinxiang Medical Uni-versity;The First Hospital Affiliated with Xinxiang Medical University;The Hospital of the Avic Xinxiang Aviation Industry(Group)Co.,Ltd)

机构地区：[1]新乡市中心医院,河南新乡453000 [2]新乡医学院 [3]新乡医学院第一附属医院 [4]航空工业新乡航空工业(集团)有限公司医院

出　　处：《中国病原生物学杂志》2020年第4期477-482,共6页Journal of Pathogen Biology

摘　　要：目的研究耐甲氧西林金黄色葡萄球菌院内感染分布和耐药机制,为耐甲氧西林金黄色葡萄球防治提供依据。方法收集金黄色葡萄球菌菌株260株,所有菌株经VTIEK-32全自动微生物鉴定仪鉴定。采用纸片扩散法测定金黄色葡萄球菌对临床常用药物的耐受性,并采用统计学工具比较耐甲氧西林金黄色葡萄球菌与甲氧西林敏感金黄色葡萄球菌对临床常用药物耐受性。采用PCR热扩增检测毒力基因和耐药基因携带情况。结果痰液、分泌物、脓液、尿液、血液和其他标本分离出金黄色葡萄球菌构成比分别为39.23%、25.38%、15.00%、8.08%、6.15%和6.15%。金黄色葡萄球菌按科室分布,急诊科、儿科、呼吸内科、神经外科、内科、妇产科、普外科和其他科室构成比分别为20.00%、17.31%、15.00%、14.23%、11.92%、10.77%、7.69%和3.08%。甲氧西林敏感和耐甲氧西林金黄色葡萄球菌对克林霉素、呋喃妥因、复方磺胺甲噁唑、四环素、红霉素、庆大霉素、阿米卡星、利福平、环丙沙星、加替沙星耐药率分别为42.96%、0.00%、21.83%、29.58%、52.82%、19.72%、0.00%、0.00%、13.38%和0.00%,78.81%、1.69%、24.58%、56.78%、86.44%、44.92%、4.24%、0.85%、32.20%和0.85%,所有菌株均未对万古霉素和替考拉宁产生耐药性。甲氧西林敏感和耐甲氧西林金黄色葡萄球菌对克林霉素、四环素、红霉素、庆大霉素、阿米卡星和环丙沙星两组耐药数据比较,数据具有统计学意义(P<0.05)。260株金黄色葡萄球菌中sea、seb、sec、hld、pvl和tst阳性率分别为43.46%、29.23%、20.00%、33.85%、25.00%和13.85%。sea在痰液、分泌物、脓液、尿液、血液和其他标本中阳性率为:70.59%、24.24%、20.51%、42.86%、18.75%和31.25%。260株金黄色葡萄球菌中mecA、ermA、ermB、ermC、aac(6//)aph(2//)、aph(3//)和tet(M)阳性率分别为:45.38%、31.54%、3.46%、29.23%、15.77%、5.77%和30.00%。118株耐甲氧西林Objectives To study the distribution of nosocomial infections involving MRSA and the mechanism of its drug resistance in order to provide a basis for the control of MRSA.Methods Two hundred and sixty strains of S.aureus were collected,and all strains were identified by a Vitek-32automated microbial identification system.The tolerance of S.aureus to drugs commonly used in clinical practice was determined using the disk diffusion test,and data on the tolerance of MRSA and MSSA to drugs commonly used in clinical practice were compared using statistical tools.Results S.aureus was isolated from sputum(25.38%),secretions(15.00%),pus(8.08%),urine(6.15%),blood(6.15%),and other specimens(39.23%).S.aureus was found in the Emergency Department(20.00%),Pediatrics(17.31%),Respiratory Medicine(15.00%),Neurosurgery(14.23%),Internal Medicine(11.92%),Gynecology and Ob-stetrics(10.77%),General Surgery(7.69%),and other departments(3.08%).The resistance of MSSA to clindamycin was 42.96%,its resistance to nitrofurantoin was 0.00%,its resistance to sulfamethoxazole was 21.83%,its resistance to tetracycline was 29.58%,its resistance to erythromycin was 52.82%,its resistance to gentamicin was 19.72%,its resistance to amikacin was 0.00%,its resistance to rifampicin was 0.00%,its resistance to ciprofloxacin was 13.38%,and its resistance to gatifloxacin was 0.00%.The resistance of MRSA to clindamycin was 78.81%,its resistance to nitro-furantoin was 1.69%,its resistance to sulfamethoxazole was 24.58%,its resistance to tetracycline was 56.78%,its resistance to erythromycin was 86.44%,its resistance to gentamicin was 44.92%,its resistance to amikacin was 4.24%,its resistance to rifampicin was 0.85%,its resistance to ciprofloxacin was 32.20%,and its resistance to gatifloxacin was 0.85%.All of the strains were susceptible to vancomycin and teicoplanin.The resistance of MSSA and MRSA to clinda-mycin,tetracycline,erythromycin,gentamicin,amikacin,and ciprofloxacin differed significantly(P<0.05).sea was de-tected in 43.46%of isolates,seb was detect

关 键 词：耐甲氧西林金黄色葡萄球菌 分布 毒力基因 耐药基因 

分 类 号：R378.11[医药卫生—病原生物学]