CAJ | 학술논문

目的研究医院环境及临床分离耐甲氧西林金黄色葡萄球菌(MRSA)分子流行病特征，为MRSA的医院感染防控提供依据。方法使用 MicroScan walkaway-40SI 全自动微生物分析仪对医院环境与临床分离MRSA进行鉴定。通过多重PCR扩增特异基因片段进行SCCmec基因分型，并应用spa分型技术进行同源性分析。结果SCCmec分型结果显示，环境分离的7株MRSA分为两型：其中SCCmecⅢ型6株；SCCmecⅣ型1株。临床分离44株 MRSA分为四型：其中SCCmecII型8株、Ⅲ型22株、Ⅳ型12株、吁型1株，未检出I型菌株，并有1株未能分型。 SCCmec Ⅲ型MRSA主要分布在新生儿监护病房(NICU)、呼吸内科、重症监护病房(ICU)和神经外科。对MRSA进行spa基因分型可见：NICU主要流行株为t437型，呼吸内科主要流行株为t030型，而ICU和神经外科流行株均为t034型，且上述科室环境与临床分离株高度同源。结论医院环境与临床分离的MRSA均以SCCmec Ⅲ型为主。 spa分型结果显示两类MRSA同源性较高，科室之间存在同型MRSA的交叉传播。 MRSA定植于医院环境是导致其医院感染流行传播的重要因素。
목적연구의원배경급림상분리내갑양서림금황색포도구균(MRSA)분자류행병특정，위MRSA적의원감염방공제공의거。방법사용 MicroScan walkaway-40SI 전자동미생물분석의대의원배경여림상분리MRSA진행감정。통과다중PCR확증특이기인편단진행SCCmec기인분형，병응용spa분형기술진행동원성분석。결과SCCmec분형결과현시，배경분리적7주MRSA분위량형：기중SCCmecⅢ형6주；SCCmecⅣ형1주。림상분리44주 MRSA분위사형：기중SCCmecII형8주、Ⅲ형22주、Ⅳ형12주、우형1주，미검출I형균주，병유1주미능분형。 SCCmec Ⅲ형MRSA주요분포재신생인감호병방(NICU)、호흡내과、중증감호병방(ICU)화신경외과。대MRSA진행spa기인분형가견：NICU주요류행주위t437형，호흡내과주요류행주위t030형，이ICU화신경외과류행주균위t034형，차상술과실배경여림상분리주고도동원。결론의원배경여림상분리적MRSA균이SCCmec Ⅲ형위주。 spa분형결과현시량류MRSA동원성교고，과실지간존재동형MRSA적교차전파。 MRSA정식우의원배경시도치기의원감염류행전파적중요인소。
Objective To research the molecular epidemiology of MRSA isolated from hospital environment and clinical specimens, in order to provide the evidence for preventing and controling the nosocomial infection caused by MRSA. Methods The identified MRSA isolated from clinical specimens and hospital environment were per-formed by MicroScan walkaway-40SI automatic microbial analyzer. The SCCmec types were determined by amplif-ying the characteristics gene fragments using multiplex PCR. The homology of MRSA was analyzed basing on spa typing results. Results The SCCmec typing results showed that 7 strains of MRSA isolated from hospital environ-ment were divided into typeⅢ (6 strains) and typeⅣ (1 strain). The 44 strains of MRSA isolated from clinical specimens were constituted with typeII (8 strains), typeⅢ (22 strains), typeⅣ(12 strains) and typeⅴ(1 strains). The typeIwas not detected and one strain had failed to type. The strains typed SCCmecⅢ were distribu-ted in department of neonatal intensive care unit (NICU), department of respiratory, department of intensive care unit (ICU),department of neurosurgery. The strains typed SCCmecⅣwere distributed in department of emergency surgery, department of general surgery. To analyze the spa genotypes of the MRSA isolated from NICU,department of respiratory,ICU and department of neurosurgery, the data showed that the t437 was the predominant type in NICU, and the t030 was the predominant type in department of Respiratory, while the t034 was the predominant type both in ICU and in department of neurosurgery. Moreover, we found that the strains isolated from environmental and clinical were highly homologous in different departments described above. Conclusion The MRSA isolated from clinical specimens and hospital environment are primarily SCCmecⅢtype. The spa typing shows that the MR-SA have highly homology between clinical strains and environmental strains. The same type of MRSA isolated from different clinical departments may caused by cross-infection. MRSA colonized in hospital environment is an impor-tant factor in its nosocomial spreading.