南京某医院成人耐甲氧西林金黄色葡萄球菌检出情况及耐药基因分析
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摘要
目的了解江苏省中西医结合医院2011—2017年成人耐甲氧西林金黄色葡萄球菌(MRSA)临床分离株的检出情况及其耐药基因,为临床合理用药提供参考依据。方法采用美国临床实验室标准化协会(CLSI)推荐方法鉴定MRSA。采用纸片扩散法对MRSA菌株进行药物敏感性试验。采用聚合酶链反应(PCR)检测β-内酰胺类耐药基因mecA,氨基糖苷修饰酶基因aac(6′)/aph(2″)、aph(3)-Ⅲ,大环内酯类23s rRNA甲基化酶基因ermA/C,四环素类核糖体保护蛋白基因tetM/K,喹诺酮类耐药基因qnrA/B和耐消毒剂基因qacA/B。结果 MRSA的总检出率为31.95%,主要分离自痰液和创口分泌物样本;检出率居前3位的科室依次为呼吸科、外科和重症监护病房。未检出对万古霉素、利奈唑胺和替加环素耐药的MRSA菌株;仅有0.49%的MRSA对奎奴普汀耐药,对复方磺胺甲噁唑、利福平、环丙沙星、四环素、庆大霉素、克林霉素、红霉素的耐药率分别为11.18%、11.57%、21.47%、63.63%、44.31%、59.41%、62.35%。多重耐药基因mecA阳性率为100%,aac(6′)/aph(2″)、aph(3)-Ⅲ、ermA/C、tetM/K、qnrA/B、qacA/B基因检出率分别为36.67%、27.94%、68.43%、57.35%、23.63%和52.45%。结论 2011—2017年江苏省中西医结合医院成人MRSA多重耐药基因检出率高。MRSA对多种抗菌药物都不同程度耐药,临床应以药物敏感性试验结果为合理用药的最主要依据。
Objective To investigate the determination and drug resistance gene of methicillin-resistant Staphylococcus aureus(MRSA) isolated from adults in Jiangsu Province Hospital on Integration of Chinese and Western Medicine from 2011 to 2017,and to provide a reference for clinical rational drug use. Methods According to the Clinical and Laboratory Standards Institute(CLSI) guidelines,MRSA were identified. The drug susceptibility was determined by disk diffusion method. The β-lactam resistance gene mecA,aminoglycoside modifying enzyme genes aac(6′)/aph(2″)and aph(3)-Ⅲ,macrolide 23 s rRNA methylase gene ermA/C,tetracycline-like ribosomal protective protein gene tetM/K,quinolone resistance gene qnrA/B and disinfectant resistance gene qacA/B were determined by polymerase chain reaction(PCR). Results The determination rate of MRSA was 31.95%,and the isolates of MRSA were mainly isolated from sputum and wound secretion samples.The top 3 departments were respiratory department,surgery department and intensive care unit. There was no MRSA isolate being resistant to vancomycin,linezolid and tigecycline. There were 0.49% MRSA isolates being resistant to quinupristin. The drug resistance rates to cotrimoxazole,rifampicin,cipro?oxacin,tetracycline,gentamicin,clindamycin and erythromycin were 11.18%,11.57%,21.47%,63.63%,44.31%,59.41% and 62.35%,respectively. The determination rate of mecA was 100%. The determination rates of aac(6′)/aph(2″),aph(3)-Ⅲ,ermA/C,tetM/K,qnrA/B and qacA/B were 36.67 %,27.94%,68.43%,57.35%,23.63% and 52.45%,respectively. Conclusions From 2011 to 2017,the determination rate of MRAS multidrug resistance gene is high.MRSA shows various degrees of drug resistance to many antibiotics. Drug susceptibility test's results can be used reference for clinical medication.
Objective To investigate the determination and drug resistance gene of methicillin-resistant Staphylococcus aureus(MRSA) isolated from adults in Jiangsu Province Hospital on Integration of Chinese and Western Medicine from 2011 to 2017,and to provide a reference for clinical rational drug use. Methods According to the Clinical and Laboratory Standards Institute(CLSI) guidelines,MRSA were identified. The drug susceptibility was determined by disk diffusion method. The β-lactam resistance gene mecA,aminoglycoside modifying enzyme genes aac(6′)/aph(2″)and aph(3)-Ⅲ,macrolide 23 s rRNA methylase gene ermA/C,tetracycline-like ribosomal protective protein gene tetM/K,quinolone resistance gene qnrA/B and disinfectant resistance gene qacA/B were determined by polymerase chain reaction(PCR). Results The determination rate of MRSA was 31.95%,and the isolates of MRSA were mainly isolated from sputum and wound secretion samples.The top 3 departments were respiratory department,surgery department and intensive care unit. There was no MRSA isolate being resistant to vancomycin,linezolid and tigecycline. There were 0.49% MRSA isolates being resistant to quinupristin. The drug resistance rates to cotrimoxazole,rifampicin,cipro?oxacin,tetracycline,gentamicin,clindamycin and erythromycin were 11.18%,11.57%,21.47%,63.63%,44.31%,59.41% and 62.35%,respectively. The determination rate of mecA was 100%. The determination rates of aac(6′)/aph(2″),aph(3)-Ⅲ,ermA/C,tetM/K,qnrA/B and qacA/B were 36.67 %,27.94%,68.43%,57.35%,23.63% and 52.45%,respectively. Conclusions From 2011 to 2017,the determination rate of MRAS multidrug resistance gene is high.MRSA shows various degrees of drug resistance to many antibiotics. Drug susceptibility test's results can be used reference for clinical medication.
引文
[1]袁挺,应春妹.成人和儿童金黄色葡萄球菌感染分子流行病学研究[J].检验医学,2015,30(11):1119-1124.
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[11]刘晔华,王世瑜,张坚磊,等.医院内感染耐甲氧西林金黄色葡萄球菌分型及临床分析[J].中华流行病学杂志,2014,35(1):71-76.
[12]LEGESE H,KAHSAY A G,KAHSAY A,et al.Nasal carriage,risk factors and antimicrobial susceptibility pattern of methicillin resistant Staphylococcus aureus a m o n g h e a lt h c a r e wo r ke r s i n Ad ig r a t a n d Wu k r o hospitals,Tigray,Nor ther n Ethiopia[J].BMC Res Notes,2018,11(1):250.
[13]UDDIN M J,AHN J.Associations between resistance phenotype and gene expression in response to serial exposure to oxacillin and ciprofloxacin in Staphylococcus aureus[J].Lett Appl Microbiol,2017,65(6):462-468.
[14]MILLER S A,KARICHU J,KOHNER P,et al.Multicenter evaluation of a modif ied cefoxitin disk diffusion method and PBP2a testing to predict mecA-mediated oxacillin resistance in atypical Staphylococcus aureus[J].J Clin Microbiol,2017,55(2):485-494.
[15]廖凤慧,王鹤,刘学佳,等.近10年我院金黄色葡萄球菌耐药性研究[J].中国医科大学学报,2018,47(1):42-47.
[16]张铃铃,陈剑云.耐甲氧西林金黄色葡萄球菌感染的药物治疗进展[J].临床合理用药杂志,2015,8(12):169-170.
[17]姜梅杰.肺炎克雷伯菌质粒介导喹诺酮类耐药基因qnrA、qnrB和qnrS的研究[J].中华临床医师杂志(电子版),2011,5(23):7136-7139.
[18]沈林海,赵岚,谢利军,等.金黄色葡萄球菌耐药基因与耐消毒剂基因的检测与分析[J].中国消毒学杂志,2016,33(8):732-734.
[19]DUPONT J,PRAT D,SZTRYMF B.Linezolid versus vancomycin in methicillin resistant Staphylococcus aureus nosocomial pneumonia in the elderly[J].Am J Emerg Med,2017,35(8):1197-1198.
[20]GARDETE S,TOMASZ A.Mechanisms of vancomycin resistance in Staphylococcus aureus[J].J Clin Invest,2014,124(7):2836-2840.
[2]张志军,曹海燕,刘延媛,等.医院感染金黄色葡萄球菌耐药表型与耐药基因研究[J].中华医院感染学杂志,2015,25(9):1924-1926.
[3]姚明,关立锋,吴银生,等.甲氧西林耐药金黄色葡萄球菌基因分型及耐药现状研究[J].中华烧伤杂志,2014,30(5):428-432.
[4]National Committee of Clinical Laboratory Standards.Performance standards for antimicrobial susceptibility testing[S].M100-S20,NCCLS,2010.
[5]黄峰,秦淑国,边其侠,等.耐甲氧西林溶血葡萄球菌耐药性及耐药基因研究[J].中国感染控制杂志,2012,11(2):91-96.
[6]刘敏,史莉,孙光成.耐甲氧西林凝固酶阴性葡萄球菌抗菌药物及消毒剂耐药基因研究[J].中华医院感染学杂志,2006,16(7):721-724.
[7]董德平,顾飞飞,陈旭,等.江苏海安地区分离的金黄色葡萄球菌的分子特征及其耐药性分析[J].检验医学,2014,29(12):1234-1237.
[8]STEFANI S,CHUNG D R,LINDSAY J A.Meticillinresist a nt Staphylococc u s aure u s(M R SA):global epidemiology and harmonisation of typing methods[J].Int JAntimicrob Agents,2012,39(4):273-282.
[9]AL MOHAJER M,MUSHER D M,MINARD C G,et al.Clinical significance of Staphylococcus aureus bacteriuria at a tertiary care hospital[J].Scand J Infect Dis,2013,45(9):688-695.
[10]PATERSON G K,MORGAN F J,HARRISON E M,et al.Prevalence and characterization of human mecCmethicillin-resistant Staphylococcus aureus isolates in England[J].J Antimicrob Chemother,2014,69(4):907-910.
[11]刘晔华,王世瑜,张坚磊,等.医院内感染耐甲氧西林金黄色葡萄球菌分型及临床分析[J].中华流行病学杂志,2014,35(1):71-76.
[12]LEGESE H,KAHSAY A G,KAHSAY A,et al.Nasal carriage,risk factors and antimicrobial susceptibility pattern of methicillin resistant Staphylococcus aureus a m o n g h e a lt h c a r e wo r ke r s i n Ad ig r a t a n d Wu k r o hospitals,Tigray,Nor ther n Ethiopia[J].BMC Res Notes,2018,11(1):250.
[13]UDDIN M J,AHN J.Associations between resistance phenotype and gene expression in response to serial exposure to oxacillin and ciprofloxacin in Staphylococcus aureus[J].Lett Appl Microbiol,2017,65(6):462-468.
[14]MILLER S A,KARICHU J,KOHNER P,et al.Multicenter evaluation of a modif ied cefoxitin disk diffusion method and PBP2a testing to predict mecA-mediated oxacillin resistance in atypical Staphylococcus aureus[J].J Clin Microbiol,2017,55(2):485-494.
[15]廖凤慧,王鹤,刘学佳,等.近10年我院金黄色葡萄球菌耐药性研究[J].中国医科大学学报,2018,47(1):42-47.
[16]张铃铃,陈剑云.耐甲氧西林金黄色葡萄球菌感染的药物治疗进展[J].临床合理用药杂志,2015,8(12):169-170.
[17]姜梅杰.肺炎克雷伯菌质粒介导喹诺酮类耐药基因qnrA、qnrB和qnrS的研究[J].中华临床医师杂志(电子版),2011,5(23):7136-7139.
[18]沈林海,赵岚,谢利军,等.金黄色葡萄球菌耐药基因与耐消毒剂基因的检测与分析[J].中国消毒学杂志,2016,33(8):732-734.
[19]DUPONT J,PRAT D,SZTRYMF B.Linezolid versus vancomycin in methicillin resistant Staphylococcus aureus nosocomial pneumonia in the elderly[J].Am J Emerg Med,2017,35(8):1197-1198.
[20]GARDETE S,TOMASZ A.Mechanisms of vancomycin resistance in Staphylococcus aureus[J].J Clin Invest,2014,124(7):2836-2840.