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
41-45
,共5页
刘彩林%陈中举%孙自镛%邱红%柯俊%史莉%张夫红%陈童%邹玖明
劉綵林%陳中舉%孫自鏞%邱紅%柯俊%史莉%張伕紅%陳童%鄒玖明
류채림%진중거%손자용%구홍%가준%사리%장부홍%진동%추구명
甲氧西林抗药性%葡萄球菌,金黄色%万古霉素%实验室技术和方法
甲氧西林抗藥性%葡萄毬菌,金黃色%萬古黴素%實驗室技術和方法
갑양서림항약성%포도구균,금황색%만고매소%실험실기술화방법
Methicillin resistance%Staphylococcus aureus%Vancomycin%Laboratory techniques and procedures
目的 了解湖北地区临床耐甲氧西林金黄色葡萄球菌(MRSA)标本中异质性万古霉素中介金黄色葡萄球菌(hVISA)的分离率,并探讨一种可用于本实验室筛选hVISA的简便易行的方法.方法 采用琼脂稀释法检测214株临床MRSA菌株的苯唑西林、头孢西丁、万古霉素、替考拉宁的MIC,并分别用含有5 mg/L替考拉宁的M-H琼脂(MHA5T),宏量E-test法(MET)及菌群分析曲线(PAP/AUC)法检测hVISA.以PAP/AUC法作为金标准,比较MHA5T和MET法的敏感度及特异度.采用Triton X-100诱导自溶的方法检测hVISA和万古霉素敏感金黄色葡萄球菌(VSSA)菌株的自溶性,并用SPSS18.0软件分析其差异性.结果 PAP/AUC、MET、MHA5T三种方法检测hVISA的阳性率分别为17.8％ (38/214)、20.6％ (44/214)、45.8％ (98/214).以PAP/AUC作为金标准,MET和MHA5T的敏感度、特异度分别为82％ (31/38)、93％ (163/176)和90％(34/38)、64％ (112/176).hVISA 4 h后自溶性降至52％,VSSA 4 h后自溶性降至28％,与VSSA相比,hVISA的自溶性明显下降(x2=18.3486,P=0.024).结论 湖北地区hVISA检出率为17.8％,应引起临床高度重视.MHA5T可作为hVISA的初筛方法,以减少PAP/AUC的繁琐工作量及E-test的使用.
目的 瞭解湖北地區臨床耐甲氧西林金黃色葡萄毬菌(MRSA)標本中異質性萬古黴素中介金黃色葡萄毬菌(hVISA)的分離率,併探討一種可用于本實驗室篩選hVISA的簡便易行的方法.方法 採用瓊脂稀釋法檢測214株臨床MRSA菌株的苯唑西林、頭孢西丁、萬古黴素、替攷拉寧的MIC,併分彆用含有5 mg/L替攷拉寧的M-H瓊脂(MHA5T),宏量E-test法(MET)及菌群分析麯線(PAP/AUC)法檢測hVISA.以PAP/AUC法作為金標準,比較MHA5T和MET法的敏感度及特異度.採用Triton X-100誘導自溶的方法檢測hVISA和萬古黴素敏感金黃色葡萄毬菌(VSSA)菌株的自溶性,併用SPSS18.0軟件分析其差異性.結果 PAP/AUC、MET、MHA5T三種方法檢測hVISA的暘性率分彆為17.8％ (38/214)、20.6％ (44/214)、45.8％ (98/214).以PAP/AUC作為金標準,MET和MHA5T的敏感度、特異度分彆為82％ (31/38)、93％ (163/176)和90％(34/38)、64％ (112/176).hVISA 4 h後自溶性降至52％,VSSA 4 h後自溶性降至28％,與VSSA相比,hVISA的自溶性明顯下降(x2=18.3486,P=0.024).結論 湖北地區hVISA檢齣率為17.8％,應引起臨床高度重視.MHA5T可作為hVISA的初篩方法,以減少PAP/AUC的繁瑣工作量及E-test的使用.
목적 료해호북지구림상내갑양서림금황색포도구균(MRSA)표본중이질성만고매소중개금황색포도구균(hVISA)적분리솔,병탐토일충가용우본실험실사선hVISA적간편역행적방법.방법 채용경지희석법검측214주림상MRSA균주적분서서림、두포서정、만고매소、체고랍저적MIC,병분별용함유5 mg/L체고랍저적M-H경지(MHA5T),굉량E-test법(MET)급균군분석곡선(PAP/AUC)법검측hVISA.이PAP/AUC법작위금표준,비교MHA5T화MET법적민감도급특이도.채용Triton X-100유도자용적방법검측hVISA화만고매소민감금황색포도구균(VSSA)균주적자용성,병용SPSS18.0연건분석기차이성.결과 PAP/AUC、MET、MHA5T삼충방법검측hVISA적양성솔분별위17.8％ (38/214)、20.6％ (44/214)、45.8％ (98/214).이PAP/AUC작위금표준,MET화MHA5T적민감도、특이도분별위82％ (31/38)、93％ (163/176)화90％(34/38)、64％ (112/176).hVISA 4 h후자용성강지52％,VSSA 4 h후자용성강지28％,여VSSA상비,hVISA적자용성명현하강(x2=18.3486,P=0.024).결론 호북지구hVISA검출솔위17.8％,응인기림상고도중시.MHA5T가작위hVISA적초사방법,이감소PAP/AUC적번쇄공작량급E-test적사용.
Objective To investigate the prevalence of hetero-resistant vancomycin intermediate Staphylococcus aureus (hVISA) from clinical methicillin-resistant Staphylococcus aureus (MRSA) in Hubei province and explore a simple method for detecting hVISA isolates.Methods The minimum inhibitory concentrations (MIC) of 214 MRSA strains to oxacillin,cefoxitin,vancomycin and teicoplanin were determined using agar dilution method.The hVISA isolates were detected by MHA5T(M-H agar containing 5mg/L teicoplanin),MET(Etest macromethod) and PAP/AUC (population analysis profiles/area under the curve).When PAP/AUC method as the gold standard,the sensitivity and specificity of MHA5T and MET methods were compared.The autolysis of hVISA and methicillin-sensitive Staphylococcus aureus (VSSA) was detected by Triton X-100 induced autolysis,SPSS18.0 software was used to analyze the differences.Results The positive rate of hVISA were 17.8％ (38/214),20.6％ (44/214),45.8％ (98/214) by PAP/AUC,MET,MHA5T,respectively.PAP/AUC method as the gold standard,the sensitivity and specificity of MET and MHA5T were 81.6％ (31/38),92.6％ (163/176) and 89.5％ (34/38),63.6％ (112/176),respectively.Four hours later,the autolysis of hVISA dropped to 52％,and VSSA isolates dropped to 28％,compared with VSSA,the autolysis of hVISA had significant decline (x2 =18.3486,P =0.024).Conclusions The prevalence of hVISA was 17.8％ in Hubei Province and should be paid attention.In order to reduce the tedious workload of doing PAP/AUC and the using of E-test,MHA5T could be used as the primary screening method of hVISA.
