中华检验医学杂志
中華檢驗醫學雜誌
중화검험의학잡지
CHINESE JOURNAL OF LABORATORY MEDICINE
2012年
3期
237-242
,共6页
赵春江%王辉%刘颖梅%曹彬%赵明泽%于勇%孙秋宁%刘亚丽%陈宏斌%陈华伟%蒋伟%韩少梅%徐英春%陈民钧
趙春江%王輝%劉穎梅%曹彬%趙明澤%于勇%孫鞦寧%劉亞麗%陳宏斌%陳華偉%蔣偉%韓少梅%徐英春%陳民鈞
조춘강%왕휘%류영매%조빈%조명택%우용%손추저%류아려%진굉빈%진화위%장위%한소매%서영춘%진민균
葡萄球菌,金黄色%葡萄球菌感染%软组织感染%序列分析%细菌毒素类
葡萄毬菌,金黃色%葡萄毬菌感染%軟組織感染%序列分析%細菌毒素類
포도구균,금황색%포도구균감염%연조직감염%서렬분석%세균독소류
Staphylococcus aureus%Staphylococcal infections%Soft tissue infections%Sequence analysis%Bacterial toxins
目的 探讨北京社区获得性甲氧西林耐药的金黄色葡萄球菌(CA-MRSA)流行和耐药情况.方法 前瞻性选择2009年1月至2010年8月北京4家医院的门诊皮肤软组织感染的501例患者,对每例患者填写病例报告表收集病史信息,分析CA-MRSA感染的危险因素.对分离标本进行病原学检查,收集所有的分离菌株.对所有分离到的金黄色葡萄球菌进行抗生素的药敏试验和分子特征的研究.结果 从皮肤软组织感染患者中总共分离到164株金黄色葡萄球菌,其中有5株被证实是CA-MRSA菌株.这5株CA-MRSA菌株SCCmec分型分别是SCCmec Ⅰ、SCCmecⅢ、SCCmecⅣ、SCCmecV和1株未分型.药敏试验结果显示CA-MRSA对β内酰胺类抗菌药物、左氧氟沙星、红霉素和克林霉素具有较高的耐药性,而对万古霉素、替考拉宁、利奈唑胺、达托霉素和复方磺胺具有较好的敏感性.对分子特征的研究显示杀白细胞毒素(PVL)基因在社区获得性甲氧西林敏感的金黄色葡萄球菌(CA-MSSA)和CA-MRSA中的阳性率分别为41.9％和2/5.其他毒素在CA-MSSA和CA-MRSA中的表达水平也相当.通过多位点序列分型(MLST)和金黄色葡萄球菌A蛋白(spa)分型发现CA-MSSA中主要的克隆是ST398 -t034、ST7-t796、ST398-t571、ST1-t127和ST188-t189；而CA-MRSA中主要的克隆是ST239-t037-SCCmec Ⅰ、ST239 4632 -SCCmecⅢ、ST59-t437-SCCmec Ⅴ和ST8-t008 -SCCmecⅣ.结论 CA-MRSA在北京地区的皮肤和软组织感染中的分离率较低,CA-MRSA的分子特征起源复杂,尚未在CA-MRSA中发现克隆传播现象,中国CA-MRSA菌株耐药率较高,甲氧西林敏感金黄色葡萄球菌(MSSA)普遍对抗菌药物敏感,临床经验治疗需合理使用抗菌药物以减缓耐药的发生.
目的 探討北京社區穫得性甲氧西林耐藥的金黃色葡萄毬菌(CA-MRSA)流行和耐藥情況.方法 前瞻性選擇2009年1月至2010年8月北京4傢醫院的門診皮膚軟組織感染的501例患者,對每例患者填寫病例報告錶收集病史信息,分析CA-MRSA感染的危險因素.對分離標本進行病原學檢查,收集所有的分離菌株.對所有分離到的金黃色葡萄毬菌進行抗生素的藥敏試驗和分子特徵的研究.結果 從皮膚軟組織感染患者中總共分離到164株金黃色葡萄毬菌,其中有5株被證實是CA-MRSA菌株.這5株CA-MRSA菌株SCCmec分型分彆是SCCmec Ⅰ、SCCmecⅢ、SCCmecⅣ、SCCmecV和1株未分型.藥敏試驗結果顯示CA-MRSA對β內酰胺類抗菌藥物、左氧氟沙星、紅黴素和剋林黴素具有較高的耐藥性,而對萬古黴素、替攷拉寧、利奈唑胺、達託黴素和複方磺胺具有較好的敏感性.對分子特徵的研究顯示殺白細胞毒素(PVL)基因在社區穫得性甲氧西林敏感的金黃色葡萄毬菌(CA-MSSA)和CA-MRSA中的暘性率分彆為41.9％和2/5.其他毒素在CA-MSSA和CA-MRSA中的錶達水平也相噹.通過多位點序列分型(MLST)和金黃色葡萄毬菌A蛋白(spa)分型髮現CA-MSSA中主要的剋隆是ST398 -t034、ST7-t796、ST398-t571、ST1-t127和ST188-t189；而CA-MRSA中主要的剋隆是ST239-t037-SCCmec Ⅰ、ST239 4632 -SCCmecⅢ、ST59-t437-SCCmec Ⅴ和ST8-t008 -SCCmecⅣ.結論 CA-MRSA在北京地區的皮膚和軟組織感染中的分離率較低,CA-MRSA的分子特徵起源複雜,尚未在CA-MRSA中髮現剋隆傳播現象,中國CA-MRSA菌株耐藥率較高,甲氧西林敏感金黃色葡萄毬菌(MSSA)普遍對抗菌藥物敏感,臨床經驗治療需閤理使用抗菌藥物以減緩耐藥的髮生.
목적 탐토북경사구획득성갑양서림내약적금황색포도구균(CA-MRSA)류행화내약정황.방법 전첨성선택2009년1월지2010년8월북경4가의원적문진피부연조직감염적501례환자,대매례환자전사병례보고표수집병사신식,분석CA-MRSA감염적위험인소.대분리표본진행병원학검사,수집소유적분리균주.대소유분리도적금황색포도구균진행항생소적약민시험화분자특정적연구.결과 종피부연조직감염환자중총공분리도164주금황색포도구균,기중유5주피증실시CA-MRSA균주.저5주CA-MRSA균주SCCmec분형분별시SCCmec Ⅰ、SCCmecⅢ、SCCmecⅣ、SCCmecV화1주미분형.약민시험결과현시CA-MRSA대β내선알류항균약물、좌양불사성、홍매소화극림매소구유교고적내약성,이대만고매소、체고랍저、리내서알、체탁매소화복방광알구유교호적민감성.대분자특정적연구현시살백세포독소(PVL)기인재사구획득성갑양서림민감적금황색포도구균(CA-MSSA)화CA-MRSA중적양성솔분별위41.9％화2/5.기타독소재CA-MSSA화CA-MRSA중적표체수평야상당.통과다위점서렬분형(MLST)화금황색포도구균A단백(spa)분형발현CA-MSSA중주요적극륭시ST398 -t034、ST7-t796、ST398-t571、ST1-t127화ST188-t189；이CA-MRSA중주요적극륭시ST239-t037-SCCmec Ⅰ、ST239 4632 -SCCmecⅢ、ST59-t437-SCCmec Ⅴ화ST8-t008 -SCCmecⅣ.결론 CA-MRSA재북경지구적피부화연조직감염중적분리솔교저,CA-MRSA적분자특정기원복잡,상미재CA-MRSA중발현극륭전파현상,중국CA-MRSA균주내약솔교고,갑양서림민감금황색포도구균(MSSA)보편대항균약물민감,림상경험치료수합리사용항균약물이감완내약적발생.
Objective To investigate the prevalence,antibiotic characteristics as well as molecular background of community-associated methicillin-sensitive Staphylococcus aureus (CA-MRSA) from patients with skin and sofi tissue infections from 4 different hospitals in Beijing.Methods Five hundred and one patients were enrolled from 4 hospitals prospectively.Patients with skin and soft tissue infections and no risk factors for healthcare-associated acquisition were included.Sample from the infection sites were collected for culture.Case report form was filled out for each patient.Antibiotic susceptibility test and molecular analysis was performed for each Staphylococcus aureus isolate.Results Totally 164 Staphylococcus aureus isolates were cultured from the patients with skin and soft tissue infections.Of them 5 isolates were CA-MRSA.These 5 CA-MRSA isolates harbored SCCmec Ⅰ, SCCmec Ⅲ, SCCmec Ⅳ,SCCmec Ⅴ and untypable,respectively.CA-MRSA was highly resistant to β-lactamase,levofloxacin,erythromycin and clindamycin,but susceptible to vancomycin,teicoplanin,linezolid,daptomycin,and trimethoprim/sulfamethoxazole.Prevalence of PVL in community-associated methicillin sensitive Staphylococcus aureus(CA-MSSA) and CA-MRSA were 41.9％ and 2/5.Other toxins expressed similarly between them.Combined with multilocus sequence typing (MLST) and spa typing,the major clones of CA-MSSA were ST398-t034,ST7-t796,ST398-t571,ST1t127,and ST188-t189,while in CA-MRSA were ST239-t037-SCCmec Ⅰ,ST239-t632-SCCmecⅢ,ST59-t437-SCCmecV,ST8-t008-SCCmecⅣ,and ST6-t701-NT.Conclusions The low prevalence of CA-MRSA in Beijing and complexity of the genetic background in CA-MRSA were observed.Clone spread is not found among CA-MRSA isolates.CA-MRSA exhibit higher resistance compared with methicillin sensitive Staphylococcus aureus (MSSA).Rational drug use scheme is called in the clinical practice to prevent development of high level resistance.
