中华检验医学杂志
中華檢驗醫學雜誌
중화검험의학잡지
CHINESE JOURNAL OF LABORATORY MEDICINE
2014年
1期
27-31
,共5页
贺文强%陈宏斌%赵春江%张菲菲%王辉
賀文彊%陳宏斌%趙春江%張菲菲%王輝
하문강%진굉빈%조춘강%장비비%왕휘
葡萄球菌,金黄色%苯唑西林%头孢西丁%抗药性,细菌%细菌分型技术
葡萄毬菌,金黃色%苯唑西林%頭孢西丁%抗藥性,細菌%細菌分型技術
포도구균,금황색%분서서림%두포서정%항약성,세균%세균분형기술
Staphylococcus aureus%Oxacillin%Cefoxitin%Drug resistance,bacterial%Bacterial typing techniques
目的 研究苯唑西林敏感mecA阳性的金黄色葡萄球菌在我国的流行、分布及分子生物学特点.方法 回顾性研究.采用琼脂稀释法对2010至2012年我国10个城市12所教学医院收集的1588株金黄色葡萄球菌进行20种抗生素药物敏感性检测.对苯唑西林敏感而头孢西丁耐药的金黄色葡萄球菌,进一步比较头孢西丁纸片扩散法、头孢西丁琼脂稀释法和苯唑西林琼脂稀释法的耐药结果.PCR法检测金黄色葡萄球菌特异基因nuc、femB及mecA,并进行分子分型,包括spa分型和SCCmec分型.使用SPSS18.0进行统计分析,以P≤0.05为差异有统计学意义.结果 根据头孢西丁和苯唑西林MIC水平,鉴定出60株苯唑西林敏感的耐甲氧西林金黄色葡萄球菌(MRSA).2010至2012年苯唑西林敏感MRSA在我国逐渐升高(P =0.05,95％ CI0.045～0.056,x2=6.099).这些菌株主要分布在我国9个城市,其中广州分离率最高,占30.0％ (18/60),其余依次为北京(18.3％,11/60),武汉(15.0％,9/60)和杭州(13.3％,8/60).这60株菌最常见于皮肤软组织感染标本(35％,21/60),其次为血标本(30％,18/60)和呼吸道标本(18.3％,11/60).药物敏感性分析显示,这些菌株对头孢西丁、红霉素、克林霉素和四环素耐药率分别为100％(60/60)、86.7％(52/60)、66.7％(40/60)和50％(30/60).根据分子分型结果显示,共有21种spa分型、5种SCCmec分型,spat437-SCCmecⅣ最常见,占25.0％ (15/60),其次为spa t437-SCCmecV,占13.3％ (8/60).结论 2010至2012年苯唑西林敏感MRSA在我国9个城市均有检出,并且检出率呈升高趋势.这种菌株主要是spa 437-SCCmecⅣ型.应当用头孢西丁代替苯唑西林检测这种类型的MRSA.mecA阳性而苯唑西林敏感的金黄色葡萄球菌是否能够用β内酰胺类进行治疗,尚需要进一步研究.
目的 研究苯唑西林敏感mecA暘性的金黃色葡萄毬菌在我國的流行、分佈及分子生物學特點.方法 迴顧性研究.採用瓊脂稀釋法對2010至2012年我國10箇城市12所教學醫院收集的1588株金黃色葡萄毬菌進行20種抗生素藥物敏感性檢測.對苯唑西林敏感而頭孢西丁耐藥的金黃色葡萄毬菌,進一步比較頭孢西丁紙片擴散法、頭孢西丁瓊脂稀釋法和苯唑西林瓊脂稀釋法的耐藥結果.PCR法檢測金黃色葡萄毬菌特異基因nuc、femB及mecA,併進行分子分型,包括spa分型和SCCmec分型.使用SPSS18.0進行統計分析,以P≤0.05為差異有統計學意義.結果 根據頭孢西丁和苯唑西林MIC水平,鑒定齣60株苯唑西林敏感的耐甲氧西林金黃色葡萄毬菌(MRSA).2010至2012年苯唑西林敏感MRSA在我國逐漸升高(P =0.05,95％ CI0.045～0.056,x2=6.099).這些菌株主要分佈在我國9箇城市,其中廣州分離率最高,佔30.0％ (18/60),其餘依次為北京(18.3％,11/60),武漢(15.0％,9/60)和杭州(13.3％,8/60).這60株菌最常見于皮膚軟組織感染標本(35％,21/60),其次為血標本(30％,18/60)和呼吸道標本(18.3％,11/60).藥物敏感性分析顯示,這些菌株對頭孢西丁、紅黴素、剋林黴素和四環素耐藥率分彆為100％(60/60)、86.7％(52/60)、66.7％(40/60)和50％(30/60).根據分子分型結果顯示,共有21種spa分型、5種SCCmec分型,spat437-SCCmecⅣ最常見,佔25.0％ (15/60),其次為spa t437-SCCmecV,佔13.3％ (8/60).結論 2010至2012年苯唑西林敏感MRSA在我國9箇城市均有檢齣,併且檢齣率呈升高趨勢.這種菌株主要是spa 437-SCCmecⅣ型.應噹用頭孢西丁代替苯唑西林檢測這種類型的MRSA.mecA暘性而苯唑西林敏感的金黃色葡萄毬菌是否能夠用β內酰胺類進行治療,尚需要進一步研究.
목적 연구분서서림민감mecA양성적금황색포도구균재아국적류행、분포급분자생물학특점.방법 회고성연구.채용경지희석법대2010지2012년아국10개성시12소교학의원수집적1588주금황색포도구균진행20충항생소약물민감성검측.대분서서림민감이두포서정내약적금황색포도구균,진일보비교두포서정지편확산법、두포서정경지희석법화분서서림경지희석법적내약결과.PCR법검측금황색포도구균특이기인nuc、femB급mecA,병진행분자분형,포괄spa분형화SCCmec분형.사용SPSS18.0진행통계분석,이P≤0.05위차이유통계학의의.결과 근거두포서정화분서서림MIC수평,감정출60주분서서림민감적내갑양서림금황색포도구균(MRSA).2010지2012년분서서림민감MRSA재아국축점승고(P =0.05,95％ CI0.045～0.056,x2=6.099).저사균주주요분포재아국9개성시,기중엄주분리솔최고,점30.0％ (18/60),기여의차위북경(18.3％,11/60),무한(15.0％,9/60)화항주(13.3％,8/60).저60주균최상견우피부연조직감염표본(35％,21/60),기차위혈표본(30％,18/60)화호흡도표본(18.3％,11/60).약물민감성분석현시,저사균주대두포서정、홍매소、극림매소화사배소내약솔분별위100％(60/60)、86.7％(52/60)、66.7％(40/60)화50％(30/60).근거분자분형결과현시,공유21충spa분형、5충SCCmec분형,spat437-SCCmecⅣ최상견,점25.0％ (15/60),기차위spa t437-SCCmecV,점13.3％ (8/60).결론 2010지2012년분서서림민감MRSA재아국9개성시균유검출,병차검출솔정승고추세.저충균주주요시spa 437-SCCmecⅣ형.응당용두포서정대체분서서림검측저충류형적MRSA.mecA양성이분서서림민감적금황색포도구균시부능구용β내선알류진행치료,상수요진일보연구.
Objective The purpose of the study is to understand the epidemiology,distribution and molecular characteristics of oxacillin susceptible mecA positive Staphylococcus aureus (S.aureus).Methods Totally 1588 S.aureus isolates collected from 12 hospitals in 10 cities of China between 2010 and 2012 were retrospectively characterized.The isolates were characterized by antimicrobial susceptibility test of 20antimicrobial drugs.Three different methods (cefoxitin disc diffusion,agar dilution for oxacillin and cefoxitin) to detect oxacillin susceptible and mecA positive S.aureus were also compared.All the strains were confirmed to be S.aureus by detecting S.aureus specific genes by PCR (including nuc,femB,and mecA gene),which was viewed as the golden standard of MRSA.The molecular typing methods included SCCmec and spa typing.The statistical analyses were carried out in statistical product and service solutions (SPSS),Version 18.0.The significance level P was set at 0.05.Results According to the MICs of cefoxitin and oxacillin,a total of 60 isolates were oxacillin susceptible methicilin resistance Staphylococcus aureus (MRSA).Based on the differences of the specimen collection date,it is found that oxacillin susceptible MRSA have increased from 2010 to 2012 (P =0.05,95％ CI 0.045-0.056,X2 =6.099).These isolates were distributed in 9 major cities,and the highest prevalence is 30.0％ (18/60) in Guangzhou,followed by Beijing (18.3％,11/60),Wuhan (15.0％,9/60),Hangzhou (13.3％,8/60).Most of the isolates were from skin soft tissue infection (35％,21/60),blood stream infection (30％,18/60) and respiratory infection specimens (18.3％,11/60).The resistance rate to cefoxitin,erythromycin,clindamycin and tetracycline was 100％ (60/60),86.7％ (52/60),66.7％ (40/60) and 50％ (30/60),respectively.The molecular characterization showed that 21 spa and 5 SCCmec types were detected.The most predominant clone was spa t437-SCCmec Ⅳ (25.0％,15/60),followed by spa t437-SCCmecV (13.3％,8/60).Conclusions The detection rate of oxacillin susceptible MRSA is significantly higher from 2010 to 2012.The major clone is t437-SCCmec Ⅳ.The use of cefoxitin should replace oxacillin in detecting this type of MRSA.Further study is needed to confirm whether beta lactam antimicrobial agents should be used in the treatment of oxacillin susceptible mecA positive S.aureus.
