2016-2022年江苏省扬州市临床分离金黄色葡萄球菌克林霉素耐药性及耐药基因分析  

Analysis of clindamycin resistance and drug resistance genes of clinical Staphylococcus aureus in Yangzhou city,Jiangsu province from 2016 to 2022

作　　者：徐娅雯 陆荣荣 许蓉蓉 朱倩 谈忠鸣[2] 周乐 Xu Yawen;Lu Rongrong;Xu Rongrong;Zhu Qian;Tan Zhongming;Zhou Le(Yangzhou Center for Disease Control and Prevention,Yangzhou 225009,Jiangsu,China;National Health Commission Key Laboratory of Enteric Pathogenic Microbiology,Jiangsu Provincial Center for Disease Control and Prevention,Nanjing 210009,Jiangsu,China)

机构地区：[1]扬州市疾病预防控制中心,江苏扬州225009 [2]国家卫生健康委员会肠道病原微生物重点实验室,江苏省疾病预防控制中心,江苏南京210009

出　　处：《疾病监测》2024年第7期875-880,共6页Disease Surveillance

基　　金：江苏省卫生健康委员会研项目(No.Z2020050)。

摘　　要：目的了解耐克林霉素金黄色葡萄球菌(SA)的耐药性及耐药基因分布情况,为耐克林霉素SA感染的诊疗及科学防治提供实验室依据。方法收集2016—2022年江苏省扬州市部分三甲医院临床检测样本分离SA,用微量肉汤稀释法检测SA耐药表型,全基因组测序分析后用多位点序列分型(MLST)方法进行分型,并在耐药基因数据库中筛选耐药基因。结果共收集到临床SA分离株200株,86株SA确定为克林霉素耐药,其中43株(43/86,50%)为诱导耐药(iMLSB)。86株SA耐药模式多样,固有耐药(cMLSB)共有15种耐药表型,其中有4株菌对6种以上药物不敏感;iMLSB共有13种耐药表型,有7株菌对6种以上药物不敏感。对9类17种耐药基因进行分析,携带超过6个耐药基因的菌株中,iMLSB占9.30%(8/86),高于cMLSB(2.33%,2/86)。86株SA分为12个不同的克隆复合体(CC),优势型别为CC398(27.90%)、CC5(15.12%)和CC59(12.79%)。结论与cMLSB相比,iMLSB对6种以上抗菌药物不敏感的菌株数更多,耐药基因携带率也更高。CC5克隆群多为iMLSB(84.62%,11/13),平均携带耐药基因数为7。扬州市iMLSB SA的耐药现状及耐药基因特征值得关注,CC5-ermA-SA在抗生素的威胁下可能更具耐受性。Objective This study aimed to investigate the drug resistance and distribution of resistant genes in clinical isolates of Staphylococcus aureus(SA)in the Yangzhou region.The laboratory findings provide valuable insights for the diagnosis,treatment,and scientific prevention of clindamycin-resistant SA infections in the local area.Methods Clinical samples of SA were collected from some tertiary hospitals in this region from 2016 to 2022.Broth microdilution method was used to detect the drug resistance phenotype of SA.MLST types were determined after whole genome sequencing analysis,and drug resistance genes were screened in the CARD database.Results A total of 200 clinical SA isolates were collected,and 86 SA were confirmed to be clindamycin resistant,of which 43(43/86,50%)were induced drug resistance(iMLSB).The clindamycin-resistant SA strains exhibited diverse resistance patterns,with 15 different phenotypes observed for cMLSB and 13 phenotypes for iMLSB.Among these,4 strains were resistant to more than six different drugs in the cMLSB group,and 7 strains were resistant to more than six drugs in the iMLSB group.Analysis of 17 resistant genes belonging to nine classes revealed that 10 strains(11.63%)carried six or more resistant genes,with a higher prevalence of iMLSB(9.30%,8/86)compared to cMLSB(2.33%,2/86).The 86 SA strains were classified into 12 different clonal complexes(CC),with CC398(27.90%)and CC5(15.12%)being the dominant types.Conclusion Compared to cMLSB,iMLSB strains of SA exhibited higher drug resistance and a greater prevalence of resistant genes.The CC5 clonal complex,with an average of 7.31 carried resistant genes,was predominantly associated with iMLSB(84.62%,11/13).The drug resistance profile and resistant gene characteristics of iMLSB SA in the local area deserve attention.The evolution pattern of CC5-ermA-SA appears unique and may confer increased tolerance to antibiotics.

关 键 词：金黄色葡萄球菌 克林霉素耐药 耐药基因 多位点序列分析 

分 类 号：R211[医药卫生—中医学] R378.1