CAJ | 학술논문

目的评估不同检测方法对纸片法头孢西丁敏感,苯唑西林耐药葡萄球菌耐药性状的检测能力,并对非mecA基因介导苯唑西林耐药的匍萄球菌进行药敏谱分析.方法收集2007年1月至2009年5月间复旦大学附属华山医院就诊患者呼吸道、尿、分泌物和无菌体液标本中分离得到的255株金黄色葡萄球菌,采用苯唑西林纸片法、苯唑西林MIC法、头孢西丁纸片法、头孢西丁MIC法枪测金黄色葡萄球菌对苯唑西林的敏感性:用苯唑西林MIC法和头孢西丁纸片法检测75株凝固酶阴性萄萄球菌对苯唑西林的敏感性:将所有葡萄球菌进行mecA基因检测,结合试验结果分析葡萄球菌苯唑西林耐药原因,并对非mecA基因介导的苯唑西林耐药葡萄球菌用MIC法进行抗菌药敏谱分析.结果 255株纸片法头孢西丁敏感、青霉素耐药的金黄色葡萄球菌苯唑西林纸片法检测出6株中介,4株耐药;头孢西丁纸片法、头孢西丁MIC法、苯唑西林MIC法全敏感、mecA基因检测全阴性.75株纸片法头孢西丁敏感、青霉素耐药的凝固酶阴性葡萄球菌,苯唑西林MIC法59株敏感,16株耐药;mecA基因阴性为71株,阳性为4株.12株非mecA基因介导苯唑西林耐药的葡萄球菌庆大霉素敏感为10株,克林霉素8株、环丙沙星11株、红霉素6株、甲氧苄啶/磺胺甲噁唑11株,头孢菌素类、替考拉宁、万古霉素、哌拉西林/他唑巴坦、四环素12株.结论金黄色葡萄球菌用头孢西丁检测mecA基因介导的苯唑西林耐药,具有很好的可靠性.凝固酶阴性葡萄球菌最好同时使用头孢西丁纸片法和苯唑西林MIC法检测mecA基因介导的苯唑西林耐药,以提高检出率.非mecA基因介导的苯唑西林耐药,临床可依据实际药物敏感实验结果选择性使用β内酰胺酶稳定的青霉素、β内酰胺酶抑制剂复合药、头孢类和碳青霉烯类药物治疗.
목적 평고불동검측방법 대지편법두포서정민감,분서서림내약포도구균내약성상적검측능력,병대비mecA기인개도분서서림내약적포도구균진행약민보분석.방법 수집2007년1월지2009년5월간복단대학부속화산의원취진환자호흡도、뇨、분비물화무균체액표본중분리득도적255주금황색포도구균,채용분서서림지편법、분서서림MIC법、두포서정지편법、두포서정MIC법창측금황색포도구균대분서서림적민감성:용분서서림MIC법화두포서정지편법검측75주응고매음성도도구균대분서서림적민감성:장소유포도구균진행mecA기인검측,결합시험결과 분석포도구균분서서림내약원인,병대비mecA기인개도적분서서림내약포도구균용MIC법진행항균약민보분석.결과 255주지편법두포서정민감、청매소내약적금황색포도구균분서서림지편법검측출6주중개,4주내약;두포서정지편법、두포서정MIC법、분서서림MIC법전민감、mecA기인검측전음성.75주지편법두포서정민감、청매소내약적응고매음성포도구균,분서서림MIC법59주민감,16주내약;mecA기인음성위71주,양성위4주.12주비mecA기인개도분서서림내약적포도구균경대매소민감위10주,극림매소8주、배병사성11주、홍매소6주、갑양변정/광알갑오서11주,두포균소류、체고랍저、만고매소、고랍서림/타서파탄、사배소12주.결론 금황색포도구균용두포서정검측mecA기인개도적분서서림내약,구유흔호적가고성.응고매음성포도구균최호동시사용두포서정지편법화분서서림MIC법검측mecA기인개도적분서서림내약,이제고검출솔.비mecA기인개도적분서서림내약,림상가의거실제약물민감실험결과 선택성사용β내선알매은정적청매소、β내선알매억제제복합약、두포류화탄청매희류약물치료.
Objective To evalue the ability of detecting the resistance of cefoxitin-sensitive,penicillin-resistant Staphylococcus by different methods and analyze the antibiotic susceptibility spectrum of coagulase-negative Staphylococcus which are non-mecA-mediated oxacillin resistance. Methods All the isolates were collected from Huashan hospital between 2007 and 2009. The isolates were recovered from various clinical sources, including respiratory tract, urine, secretion and sterile fluids samples. The oxacillin susceptibility of Staphylococcus aureus was determined by cefoxitin disk diffusion test, cefoxitin MIC test,oxacillin disk diffusion test and oxacillin MIC test Likewise, the oxacillin susceptibility of coagulasenegative Staphylococcus was determined by cefoxitin disk diffusion test and oxacillin MIC test. All the isolates with sensitive to cefoxitin were screened for the mec A gene by PCR Finally, the MIC of non-mecA-mediated oxacillin-resistant Staphylococcus were determined. Results Among 255 cefoxitin disk diffusion test sensitive and penicillin-resistant Staphylococcus aureus, 6 isolates were intermediated to oxacillin and 4 were resistant by oxacillin disk diffusion test, but all the isolates were sensitive by the cefoxitin disk diffusion test,cefoxitin MIC test and oxacillin MIC test. Among 75 cefoxitin disk diffusion test sensitive and penicillin-resistant coagulase-negative Staphylococcus, 16 isolates were resistant to oxacillin by oxacillin MIC method and 4 carried mecA gene. Among 12 non-mecA-mediated oxacillin-resistant Staphylococcus, the susceptible isolates of gentamicin is 10, clindamycin is 8, ciprofloxacin is 11, erythrornycin is 6, trimethoprim/sulfamethoxazo]e is 11 ,and cephalosporins, teicoplaninl, vancomycin, piperacillin/tazobactam, tetracycline are all 12. Conclusions The cefoxitin disk diffusion test can reliably predict mecA-mediated oxacillin resistant Staphylococcus aureus. It would be best to combine cefoxitin disk diffusion test and oxacillin MIC test to improve accuracy of detection of mecA-mediated oxacillin resistant coagulase-negative Staphylococcus.Furthermore, infections due to the non-mecA-mediated oxacillin resistant coagulase-negative Staphylococcus can be treated by penicillinase-stable penicillins, β-lactam/β-lactam inhibitor combinations, relevant cephems and carbapenems.