CAJ | 학술논문

目的了解上海地区甲氧西林耐药的金黄色葡萄球菌(MRSA)的耐药性及分子流行病学特点.方法从上海5所医院收集140株MRSA,采用琼脂稀释法和肉汤稀释法检测其耐药性;利用PCR方法检测MRSA的PVL基因和SCCmec型别;采用脉冲场凝胶电泳(PFGE)技术对MRSA做同源性分析并且将主要流行型别的39株MRSA进行spa分型.结果 140株MRSA对庆大霉素、磺胺甲嚼唑和克林霉素的耐药率分别为98.6%(138/140)、98.6%(138/140)和97.9%(137/140);对红霉素、环丙沙星和四环素的耐药率均在80%以上,对利福平的耐药率为10.7%(15/140);未发现对达托霉素、替考拉宁和万古霉素耐药的菌株.菌株MRSA PvL均为阴性,以SCCmecⅢ为主,达45.7%(64/140);其他型别依次为SCCmecⅢ a 25.0%(35/140)、SCCmecⅢb 14.3%(20/140)、SCCmecⅢ10.7%(15/140).SCCmecⅣ最少,占4.3%(6/140).PFGE图谱有16种类型(A～P型),以C型[30.7%(43/140)]、B型[13.6%(191140)]和Ⅰ型[10.7%(15/140)]为主;对主要流行克隆的39株MRSA进行spa分型,共得到t002[33.33%(13/39)]、t030[12.82%(5/39)]、t037[51.28%(20/39)]、t459[2.57%(1/39)]4种类型.结论上海地区5所医院MRSA共有16种流行克隆株和4种spa型,其中PVL阴性、SCCmecⅢ对红霉素、环丙沙星、克林霉素、四环素、庆大霉素、磺胺甲唑耐药的MRSA克隆可能是上海地区HA-MRSA主要流行克隆株,是医院感染控制的重点,因此临床医生在治疗HA-MRSA感染患者时,要谨慎使用抗菌药物.
목적 료해상해지구갑양서림내약적금황색포도구균(MRSA)적내약성급분자류행병학특점.방법 종상해5소의원수집140주MRSA,채용경지희석법화육탕희석법검측기내약성;이용PCR방법검측MRSA적PVL기인화SCCmec형별;채용맥충장응효전영(PFGE)기술대MRSA주동원성분석병차장주요류행형별적39주MRSA진행spa분형.결과 140주MRSA대경대매소、광알갑작서화극림매소적내약솔분별위98.6%(138/140)、98.6%(138/140)화97.9%(137/140);대홍매소、배병사성화사배소적내약솔균재80%이상,대리복평적내약솔위10.7%(15/140);미발현대체탁매소、체고랍저화만고매소내약적균주.균주MRSA PvL균위음성,이SCCmecⅢ위주,체45.7%(64/140);기타형별의차위SCCmecⅢ a 25.0%(35/140)、SCCmecⅢb 14.3%(20/140)、SCCmecⅢ10.7%(15/140).SCCmecⅣ최소,점4.3%(6/140).PFGE도보유16충류형(A～P형),이C형[30.7%(43/140)]、B형[13.6%(191140)]화Ⅰ형[10.7%(15/140)]위주;대주요류행극륭적39주MRSA진행spa분형,공득도t002[33.33%(13/39)]、t030[12.82%(5/39)]、t037[51.28%(20/39)]、t459[2.57%(1/39)]4충류형.결론 상해지구5소의원MRSA공유16충류행극륭주화4충spa형,기중PVL음성、SCCmecⅢ대홍매소、배병사성、극림매소、사배소、경대매소、광알갑서내약적MRSA극륭가능시상해지구HA-MRSA주요류행극륭주,시의원감염공제적중점,인차림상의생재치료HA-MRSA감염환자시,요근신사용항균약물.
Objective To investigate antibiotic resistance and molecular epidemiology profile of methicillin-resistant Staphylococcus aureus (MRSA) in Shanghai. Methods The antibiograms of 140 MRSA isolates from 5 hospitals for 13 drugs were analyzed by agar dilution and broth dilution. The PVL gene and SCCmec were detected by PCR; The clonal relatedness of 140 isolates were determined by PFGE and 39 strains were chosen to be characterized further by spa typing. Results All 140 MRSA are PVL negative and most of them were identified as SCCmec Ⅲ [45.7% (64/140)], followed by SCCmec Ⅲ a [25.0% (35/140)], SCCmecⅢb [14.3% (20/140)], SCCmecⅡ [10.7% (15/140)] and SCCmecⅣ [4.3% (6/140)]. All isolates were susceptible to vancomycin, teicoplanin and daptomycin. The resistance to gentamicin, sulphamethoxazole and clindamycin was 98. 6% (138/140), 98. 6% (137/140) and 97. 9% (137/140), respectively. Resistance to erythromycin, ciprofloxacin and tetracycline was above 80%, and resistance to rifampicin was 10. 7% (15/140). Sixteen different PFGE patterns(A-P) were found and most of MRSA belonged to group C[30. 7% (43/140)] ,B[13.6% (19/140)]and Ⅰ [10. 7% (15/140)]. Among 39 strains with prevalent PFGE patterns, 4 spa genotypes were identified: t002133. 33% (13/39)] ,t030 [12. 82% (5/39)] ,t037[51.28% (20/39)]and t459[2. 57% (1/39)]. Conclusions Sixteen different PFGE patterns and 4 spa genotypos were found from 5 hospitals in Shanghai. The most popular MRSA clone is PVL negative, SCCmec Ⅲ, with resistant profile of erythromycin, ciprofloxacin,clindamycin,etracycline, gentamicin,and sulphamethoxazole [E-C-L-T-G-M-]. This result suggests that hospital infection control and reasonable antibiotic usage are critical.