社区与医院获得性耐甲氧西林金黄色葡萄球菌分子特征及耐药性比较  

Comparison of molecular characteristics and drug resistance between community-acquired and hospital-acquired methicillinresistant staphylococcus aureus

作　　者：张海旺[1] 梁美春[2] 周宜庆 阮永春[1] 李明晖[1] 王丹 茅国峰[2] 苏美霞[1] 于丽侠[1] ZHANG Haiwang;LIANG Meichun;ZHOU Yiqing;RUAN Yongchun;LI Minghui;WANG Dan;MAO Guofeng;SU Meixia;YU Lixia(Department of Infectious Disease,Shaoxing People's Hospital,Shaoxing 312000,China;不详)

机构地区：[1]绍兴市人民医院感染科,312000 [2]绍兴市人民医院检验科

出　　处：《浙江医学》2023年第21期2268-2273,共6页Zhejiang Medical Journal

基　　金：浙江省卫生健康科技计划项目(2021KY1136);绍兴市科技计划项目(2018C30100)。

摘　　要：目的比较社区获得性耐甲氧西林金黄色葡萄球菌(CA-MRSA)与医院获得性耐甲氧西林金黄色葡萄球菌(HA-MRSA)的分子分型、毒力基因及耐药基因。方法选取2019年1月至2020年12月绍兴市人民医院收治的34例门诊及住院患者,共分离获得耐甲氧西林金黄色葡萄球菌(MRSA)34株,其中CA-MRSA 7株(占20.6%),HA-MRSA 27株(占79.4%)。采用头孢西丁纸片扩散法进行药敏试验,全基因组测序法进行分子分型[包括葡萄球菌mec盒式染色体(SCCmec)分型、葡萄球菌A蛋白(spa)分型、多位点基因序列类型(MLST)分型]、毒力基因及耐药基因检测。结果CA-MRSA对庆大霉素、左氧氟沙星、利福平、磷霉素、四环素均敏感,对复方新诺明的敏感率为85.7%;HA-MRSA对庆大霉素、利福平、复方新诺明、四环素的敏感率均在80%以上。两种不同来源菌株对各种常用抗菌药物敏感率以及SCCmec、spa、MLST分型比例比较,差异均无统计学意义(均P>0.05)。CA-MRSA的lukF-PV、lukS-PV检出率均明显高于HA-MRSA菌株(均P<0.05),sea检出率明显低于CA-MRSA菌株(P<0.05)。HA-MRSA的环丙沙星耐药基因gyrA检出率明显高于CA-MRSA菌株,差异有统计学意义(P<0.05)。CA-MRSA同时携带1~6种抗菌药物耐药基因,头孢西丁-青霉素-克林霉素-红霉素为优势耐药谱;HA-MRSA同时携带1~9种抗菌药物耐药基因,头孢西丁-青霉素-克林霉素-红霉素、阿米卡星-妥布霉素-头孢西丁-青霉素-环丙沙星-克林霉素-红霉素和庆大霉素-阿米卡星-妥布霉素-头孢西丁-青霉素-环丙沙星-四环素-克林霉素-红霉素为优势耐药谱。结论本院CA-MRSA分离率较高,其携带毒力基因lukF-PV、lukS-PV的比例高于HA-MRSA。Objective To compare molecular typing,virulence genes,and resistance genes between communityacquired methicillin-resistant staphylococcus aureus(CA-MRSA)and hospital-acquired methicillin-resistant staphylococcus aureus(HA-MRSA).Methods A total of 34 strains of methicillin-resistant staphylococcus aureus(MRSA)were isolated from 34 outpatient and inpatient patients admitted to Shaoxing People's Hospital from January 2019 to December 2020.Among which,7(20.6%)strains were from CA-MRSA,while 27(79.4%)from HA-MRSA.Drug sensitivity testing was conducted using cefoxitin disk diffusion method,and molecular typing[including staphylococcal cassette chromosome mec(SCCmec),staphylococcal protein A(spa),multilocus sequence typing(MLST)],as well as virulence and resistance gene testing were performed using whole genome sequencing method.Results CA-MRSA strains were sensitive to gentamicin,levofloxacin,rifampicin,fosfomycin and tetracycline,while their sensitivity rate to compound sulfamethoxazole was 85.7%.The sensitivity rates of HA-MRSA strains to gentamicin,rifampicin,compound sulfamethoxazole,and tetracycline were all above 80%.There were no statistically significant differences in the sensitivity of the two strains to various commonly used antibacterial drugs and in the proportion of SCCmec,spa,and MLST typing(all P>0.05).The detection rates of lukF-PV and lukS-PV in CA-MRSA strains were significantly higher than those in HA-MRSA strains(all P<0.05),while the detection rate of sea was significantly lower than that in CA-MRSA strains(P<0.05).The detection rate of gyrA,a ciprofloxacin resistant gene,in the HA-MRSA strain was significantly higher than that in the CA-MRSA strain,with a statistically significant difference(P<0.05).The CA-MRSA strains simultaneously carried 1-6 antibiotic resistance genes,with cefoxitin-penicillin-clindamycin-erythromycin as the dominant resistance spectrum;The HA-MRSA strains simultaneously carried 1-9 antibiotic resistance genes,with cefoxitin-penicillin-clindamycin-erythromycin,amikacin-tobra

关 键 词：社区获得性耐甲氧西林金黄色葡萄球菌 医院获得性耐甲氧西林金黄色葡萄球菌 分子特征 毒力基因 耐药基因 

分 类 号：R446.5[医药卫生—诊断学]