呼吸重症监护室耐甲氧西林金黄色葡萄球菌分子流行病学调查  

Molecular epidemiology investigations of methicillin-resistant Staphylococcus aureus in RICU

作　　者：曾军[1] 孟千琳 李奇 马春兰[1] 郑鹏城 李万成[1] ZENG Jun;MENG Qian-lin;LI Qi;MA Chun-lan;ZHENG Peng-cheng;LI Wan-cheng(Department of Respiratory and Critical Care Medicine,The First Affiliated Hospital of Chengdu Medical College,Chengdu,Sichuan 610500,China;Chengdu Medical College,Chengdu,Sichuan 610500,China)

机构地区：[1]成都医学院第一附属医院呼吸与危重症医学科,四川成都610500 [2]成都医学院,四川成都610500

出　　处：《临床肺科杂志》2022年第3期397-400,共4页Journal of Clinical Pulmonary Medicine

基　　金：四川省科技厅应用基础研究项目(No.2021YJ0470)。

摘　　要：目的调查呼吸重症监护室(RICU)病房耐甲氧西林金黄色葡萄球菌(MRSA)来源、分子分型及药敏,并提供治疗建议。方法选取成都医学院第一附属医院RICU病房2017年1月至2020年12月从43例病人痰标本、肺泡灌洗液、血液、尿液标本等分离出的52株MRSA,统计标本来源。采用琼脂稀释法进行药敏试验;采用多位点序列分型(MLST)及SCCmec方法对其进行分型。结果超过50%MRSA分离菌株来源于呼吸系统标本,其次为血液、胸腔引流液、皮肤软组织、尿液、腹腔引流液。药敏实验显示MRSA对苯唑西林、头孢唑林完全耐药,对红霉素的耐药率高达84.62%,对克林霉素、四环素、左氧氟沙星的耐药率分别为48.08%、28.85%及32.69%。对莫西沙星、甲氧苄啶/磺胺甲噁唑、庆大霉素耐药率相对较低,分别为17.31%、13.46%及15.38%,对利奈唑胺、替加环素、替考拉宁及万古霉素均未出现耐药。52株MRSA共有13个MLST型,主要为ST59(21株)及ST5(14株);共鉴定出5种SCCmec型,主要为Ⅳ型(36株)及Ⅲ型(10株)。结论 RICU病房MRSA主要来源于呼吸系统,对常用抗生素的耐药率高,可根据分型检测结果及耐药性分布特征,指导治疗策略选择。Objective To investigate the source,genotyping,and drug resistance of methicillin-resistant Staphylococcus aureus(MRSA)isolated from the respiratory intensive care unit(RICU),and provide treatment recommendations.Methods A total of 52 MASA isolates were collected from sputum,bronchoalveolar lavage fluid(BALF),blood,and urine specimens in 43 patients treated in RICU from January 2017 to December 2020,and specimen originswere counted.A susceptibility test was carried out using the agar dilution method.Multiple locus sequence typing(MLST)and the SCCmec genotyping method were used to genotyping those isolated MRSA.Results More than 50%of MRSA were isolated from the respiratory system,followed by blood,pleural drainage liquid,skin and soft tissue,urine,and abdominal drainage liquid.Antimicrobial susceptibility testing results showed MRSA were completely resistant to oxacillin and cefazolin,the resistance rate to erythromycin was as high as 84.62%,and the resistance rate to clindamycin,tetracycline,and levofloxacin were 48.08%,28.85%,and 32.69%,respectively.Furthermore,the resistance rate to moxifloxacin,trimethoprim/sulfamethoxazole,and gentamycin were 17.31%,13.46%,and 15.38%,respectively.Most notably,there was no resistance to linezolid,tigecycline,and vancomycin.In addition,there were 13 MLST types in 52 MRSA strains,mainly ST59(21 strains)and ST5(14 strains),and a total of 5 types of SCCmec were identified,mainly including type IV(36 strains)and type III(10 strains).Conclusion MRSA in RICU is mainly from the respiratory system,and the resistance rate to commonly used antibiotics is very high.The selection of treatment strategies can be guided according to the typing test results and the distribution characteristics of drug resistance.

关 键 词：耐甲氧西林金黄色葡萄球菌 分子分型 药敏实验 呼吸重症监护室 

分 类 号：R446.5[医药卫生—诊断学]