目的 调查荆州地区社区相关性和医院相关性耐甲氧西林金黄色葡萄球菌(CA-MRSA和HA-MRSA)的流行和耐药特征.方法 连续收集2012年1月至2013年12月分离自荆州市中心医院门诊和住院患者送检样本的MRSA 159株.检测16种抗菌药物对所有菌株的最小抑菌浓度,采用多重PCR检测所有菌株的SCCmec分子型别,并分别以脉冲场凝胶电泳(PFGE)和耐药谱聚类分析对ICU的MRSA进行同源性分析.采用WHONET 5.6和SPSS 19.0软件对相关数据进行统计分析.结果 159株MRSA中,HA-MRSA 131株(82.4％),CA-MRSA 28株(17.6％).HA-MRSA和CA-MRSA在患者年龄、病区分布、来源样本类型、住院时间、抗感染治疗时间、感染类型和基础疾病的构成上差异有统计学意义(x2=19.103,31.372,59.756,71.703,54.153,59.756和54.232,P＜0.01).159株MRSA中未检出对万古霉素、利奈唑胺、替加环素和呋喃妥因耐药的菌株,但所有菌株对青霉素、头孢西丁和苯唑两林均耐药.HA-MRSA对莫西沙星、利福平、左氧氟沙星、环丙沙星和庆大霉素的耐药性高于CA-MRSA(x2=30.179,27.352,28.523,28.523和25.987,P＜0.01),但对红霉素和克林霉素的耐药性低于CA-MRSA(x2=13.106和11.743,P＜0.01).159株MRSA中,SCCmecⅡ型12株(7.5％),Ⅲ型113株(71.1％),Ⅳ型26株(16.4％),未能分型8株,CA-MRSA和HA-MRSA分别以Ⅳ(26/28,92.9％)型和Ⅲ型(113/131,86.3％)为主.ICU病区分离的49株HA-MRSA,经PFGE分型可分为6型,以Al(24株,49.0％)、A2亚型(9株,18.4％)和B型(9株,18.4％)为主;耐药谱聚类分析发现3群相关性很高的HA-MRSA,其对应的PFGE型别显示其分属于A1、A2亚型和B型.结论 荆州地区流行的MRSA以HA-MRSA为主,其与CA-MRSA在患者年龄、病区分布、感染类型以及耐药性等方面均显示出差异.HA-MRSA以SCCmecⅢ型为主,且在ICU病区存在HA-MRSA暴发流行.
目的 調查荊州地區社區相關性和醫院相關性耐甲氧西林金黃色葡萄毬菌(CA-MRSA和HA-MRSA)的流行和耐藥特徵.方法 連續收集2012年1月至2013年12月分離自荊州市中心醫院門診和住院患者送檢樣本的MRSA 159株.檢測16種抗菌藥物對所有菌株的最小抑菌濃度,採用多重PCR檢測所有菌株的SCCmec分子型彆,併分彆以脈遲場凝膠電泳(PFGE)和耐藥譜聚類分析對ICU的MRSA進行同源性分析.採用WHONET 5.6和SPSS 19.0軟件對相關數據進行統計分析.結果 159株MRSA中,HA-MRSA 131株(82.4％),CA-MRSA 28株(17.6％).HA-MRSA和CA-MRSA在患者年齡、病區分佈、來源樣本類型、住院時間、抗感染治療時間、感染類型和基礎疾病的構成上差異有統計學意義(x2=19.103,31.372,59.756,71.703,54.153,59.756和54.232,P＜0.01).159株MRSA中未檢齣對萬古黴素、利奈唑胺、替加環素和呋喃妥因耐藥的菌株,但所有菌株對青黴素、頭孢西丁和苯唑兩林均耐藥.HA-MRSA對莫西沙星、利福平、左氧氟沙星、環丙沙星和慶大黴素的耐藥性高于CA-MRSA(x2=30.179,27.352,28.523,28.523和25.987,P＜0.01),但對紅黴素和剋林黴素的耐藥性低于CA-MRSA(x2=13.106和11.743,P＜0.01).159株MRSA中,SCCmecⅡ型12株(7.5％),Ⅲ型113株(71.1％),Ⅳ型26株(16.4％),未能分型8株,CA-MRSA和HA-MRSA分彆以Ⅳ(26/28,92.9％)型和Ⅲ型(113/131,86.3％)為主.ICU病區分離的49株HA-MRSA,經PFGE分型可分為6型,以Al(24株,49.0％)、A2亞型(9株,18.4％)和B型(9株,18.4％)為主;耐藥譜聚類分析髮現3群相關性很高的HA-MRSA,其對應的PFGE型彆顯示其分屬于A1、A2亞型和B型.結論 荊州地區流行的MRSA以HA-MRSA為主,其與CA-MRSA在患者年齡、病區分佈、感染類型以及耐藥性等方麵均顯示齣差異.HA-MRSA以SCCmecⅢ型為主,且在ICU病區存在HA-MRSA暴髮流行.
목적 조사형주지구사구상관성화의원상관성내갑양서림금황색포도구균(CA-MRSA화HA-MRSA)적류행화내약특정.방법 련속수집2012년1월지2013년12월분리자형주시중심의원문진화주원환자송검양본적MRSA 159주.검측16충항균약물대소유균주적최소억균농도,채용다중PCR검측소유균주적SCCmec분자형별,병분별이맥충장응효전영(PFGE)화내약보취류분석대ICU적MRSA진행동원성분석.채용WHONET 5.6화SPSS 19.0연건대상관수거진행통계분석.결과 159주MRSA중,HA-MRSA 131주(82.4％),CA-MRSA 28주(17.6％).HA-MRSA화CA-MRSA재환자년령、병구분포、래원양본류형、주원시간、항감염치료시간、감염류형화기출질병적구성상차이유통계학의의(x2=19.103,31.372,59.756,71.703,54.153,59.756화54.232,P＜0.01).159주MRSA중미검출대만고매소、리내서알、체가배소화부남타인내약적균주,단소유균주대청매소、두포서정화분서량림균내약.HA-MRSA대막서사성、리복평、좌양불사성、배병사성화경대매소적내약성고우CA-MRSA(x2=30.179,27.352,28.523,28.523화25.987,P＜0.01),단대홍매소화극림매소적내약성저우CA-MRSA(x2=13.106화11.743,P＜0.01).159주MRSA중,SCCmecⅡ형12주(7.5％),Ⅲ형113주(71.1％),Ⅳ형26주(16.4％),미능분형8주,CA-MRSA화HA-MRSA분별이Ⅳ(26/28,92.9％)형화Ⅲ형(113/131,86.3％)위주.ICU병구분리적49주HA-MRSA,경PFGE분형가분위6형,이Al(24주,49.0％)、A2아형(9주,18.4％)화B형(9주,18.4％)위주;내약보취류분석발현3군상관성흔고적HA-MRSA,기대응적PFGE형별현시기분속우A1、A2아형화B형.결론 형주지구류행적MRSA이HA-MRSA위주,기여CA-MRSA재환자년령、병구분포、감염류형이급내약성등방면균현시출차이.HA-MRSA이SCCmecⅢ형위주,차재ICU병구존재HA-MRSA폭발류행.
Objective To investigate the epidemiology and antibiotic resistance of communityassociated and hospital-associated meticillin-resistant Staphylococcus aureus (CA-MRSA and HA-MRSA) in Jingzhou.Methods A total of 159 MRSA isolates were successively collected from patients in Jingzhou Central Hospital during January 2012 and December 2013.The minimum inhibitory concentrations of 16 antimicrobial agents against 159 MRSA isolates were detected.SCCmec types of the strains were detected by multiplex PCR,and the homology of the strains was analyzed using pulsed field gel electrophoresis (PFGE) and cluster analysis of antibiogram.WHONET 5.6 and SPSS 19.0 were used for data analysis.Results Among 159 MRSA strains,131 were hospital-associated,and 28 were community-associated,which accounted for 82.4％ and 17.6％,respectively.There were significant differences in the age of patients,ward distribution,specimen type,length of stay,length of anti-infection treatment,type of infection and underlying diseases between patients with CA-MRSA or HA-MRSA infections (x2 =19.103,31.372,59.756,71.703,54.153,59.756 and 54.232,all P ＜ 0.01).No vancomycin,linezolid,tigecyeline and nitrofurantoin resistant strains were found,but all strains were resistant to penicillin,cefoxitin and oxacillin.HA-MRSA had higher resistance rates to moxifloxacin,levofloxacin,rifampicin,ciprofloxacin and gentamicin than CA-MRSA (x2 =30.179,27.352,28.523,28.523 and 25.987,all P ＜ 0.01),but its resistance rates to erythromycin and clindamycin were lower (x2 =13.106 and 11.743,both P ＜ 0.01).Among 159 MRSA strains,12 (7.5％) were of SCCmec type Ⅱ,113 (71.1％) were of SCCmec type Ⅲ,26 (16.4％) were of SCCmec type Ⅳ,and 8 were of undifferentiated type.The predominant SCCmec types were type Ⅳ for CA-MRSA (26/28,92.9％) and type Ⅲ for HA-MRSA (113/131,86.3％),respectively.Six PFGE patters were found in 49 HA-MRSA isolates from ICU,and the predominant patters were A1 (24,49.0％),A2 (9,18.4％) and B (9,18.4％).Cluster analysis of antibiogram showed that three groups of HA-MRSA were of high correlations,and they were of PFGE patter A1,A2 and B,respectively.Conclusions HA-MRSA is the predominant MRSA in Jingzhou area,and it is different from CA-MRSA in the age of patients,ward distribution,type of infection and antibiotic resistance.Most HA-MRSA strains are of type SCCmec Ⅲ,and may cause epidemic outbreak in ICU.
