CAJ | 학술논문

目的了解儿童临床分离的耐甲氧西林金黄色葡萄球菌(MRSA)耐药基因携带及其对抗菌药物耐药的状况.方法收集复旦大学附属儿科医院2009年3月至2011年11月因感染性疾病住院患儿中采集标本分离的MRSA株.PCR法检测mecA、ermA、ermB、ermC、aac(6')/aph(2")、aph(3')-Ⅲ、ant(4',4")和qacA基因,纸片扩散法检测MRSA对常用抗菌药物的耐药性.数据统计采用卡方检验.结果 37株MRSA中,mecA基因均阳性;ermB阳性9株,占24.3％,而ermA、ermC均为阴性;aac(6’)/aph(2")阳性21株,占56.8％;aph(3')-Ⅲ阳性10株,占27.0％;ant(4',4")阳性6株,占16.2％;qacA阳性9株,占24.3％.医院获得性MRSA(HA-MRSA)中aac(6’)/aph(2")的检出率为85.7％,明显高于社区获得性MRSA (CA-MRSA)的18.8％(x2 =60.340,P=0.000).37株MRSA对青霉素、氨苄西林/舒巴坦、头孢唑啉、头孢西丁、头孢呋辛耐药率均为100.0％,对替考拉宁、万古霉素、利奈唑胺均敏感.CA-MRSA和HA-MRSA对庆大霉素(12.5％比81.0％,x2=17.033,P=0.000),左氧氟沙星(31.2％比71.4％,x2=5.903,P=0.017),利福平(6.2％比61.9％,x2=11.959,P=0.001)的耐药率比较,差异均有统计学意义.携带aac(6')/aph(2")株对庆大霉素的耐药率明显高于未携带株,差异有统计学意义(x2=29.757,P=0.000).结论儿童临床分离的MRSA携带多种耐药基因,表现出多重耐药性.HA-MRSA与CA-MRSA相比,其对抗菌药物耐药率和耐药基因携带率更高.
목적 료해인동림상분리적내갑양서림금황색포도구균(MRSA)내약기인휴대급기대항균약물내약적상황.방법 수집복단대학부속인과의원2009년3월지2011년11월인감염성질병주원환인중채집표본분리적MRSA주.PCR법검측mecA、ermA、ermB、ermC、aac(6')/aph(2")、aph(3')-Ⅲ、ant(4',4")화qacA기인,지편확산법검측MRSA대상용항균약물적내약성.수거통계채용잡방검험.결과 37주MRSA중,mecA기인균양성;ermB양성9주,점24.3％,이ermA、ermC균위음성;aac(6’)/aph(2")양성21주,점56.8％;aph(3')-Ⅲ양성10주,점27.0％;ant(4',4")양성6주,점16.2％;qacA양성9주,점24.3％.의원획득성MRSA(HA-MRSA)중aac(6’)/aph(2")적검출솔위85.7％,명현고우사구획득성MRSA (CA-MRSA)적18.8％(x2 =60.340,P=0.000).37주MRSA대청매소、안변서림/서파탄、두포서람、두포서정、두포부신내약솔균위100.0％,대체고랍저、만고매소、리내서알균민감.CA-MRSA화HA-MRSA대경대매소(12.5％비81.0％,x2=17.033,P=0.000),좌양불사성(31.2％비71.4％,x2=5.903,P=0.017),리복평(6.2％비61.9％,x2=11.959,P=0.001)적내약솔비교,차이균유통계학의의.휴대aac(6')/aph(2")주대경대매소적내약솔명현고우미휴대주,차이유통계학의의(x2=29.757,P=0.000).결론 인동림상분리적MRSA휴대다충내약기인,표현출다중내약성.HA-MRSA여CA-MRSA상비,기대항균약물내약솔화내약기인휴대솔경고.
Objective The aim of this study was to study the antibiotic resistance and resistance genes of methicillin-resistant Staphylococcus aureus (MRSA) in children from Shanghai area,and to determine the relationship between phenotypic and genotypic resistance profiles.Methods In this study,a total of 37 MRSA strains isolated from clinical specimens of hospitalized patients in Children's Hospital of Fudan University from March 2009 to November 2011 were collected.The mecA,ermA,ermB,ermC,aac (6') /aph (2"),aph (3')-Ⅲ,ant (4',4"),and qacA genes were detected by polymerase chain reaction (PCR).Resistance to antibiotics was detected by agar dilution tests.The data analysis was done by chi square test.Results Among the 37 MRSA isolates,all (100.0 ％) were mecA gene positive,9 (24.3％) were ermB gene positive,none was ermA/C gene positive,21 (56.8％) were aac (6')/aph (2") gene positive,10 (27.0％) were aph (3')-Ⅲ gene positive,6 (16.2％) were ant(4',4") gene positive,and 9 were qacA gene positive (24.3％).The positive rate of aac(6')/aph(2") in hospital acquired methicillin-resistant Staphylococcus aureus (HA-MRSA) was significantly higher than that of community acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) (85.7％ vs18.8％,x2=60.340,P=0.000).Among the 37 MRSAisolates,37 (100.0％) were resistant to penicillin,ampicillin-sulbactam,cefazolin,cefoxitin and cefuroxime.The 37 isolates were all susceptible to teicoplanin,vancomycin,and linezolid.The resistant rates to gentamicin,erythromycin,clindamycin,sulfamethoxazole,fosfomycin,rifampicin,and levofloxacin were 51.4％ (19/37),81.1％ (30/37),51.4％ (19/37),16.2％ (6/37),27.0％ (10/37),37.8％ (14/37) and 54.0％ (20/37),respectively.Compared with CA-MRSA,HAMRSA isolates had significantly higher resistance rates to gentamicin (12.5％ vs 81.0％; x2 =17.033,P=0.000),levofloxacin (31.2％ vs 71.4％; x2 =5.903,P=0.017),and rifampin (6.2％ vs 61.9％; x2=11.959,P=0.001).The rate of gentamicin resistance in aac(6')/aph(2") gene carrying strains was significantly higher than strains not carrying the gene (x2 =29.757,P=0.000).Conclusions MRSA in children carry a variety of drug-resistant genes,showed multi-drug resistance.HA-MRSA carries more resistance genes,and has higher rates resistance to antimicrobials than CA-MRSA.