内蒙古三甲综合医院ICU分离MRSA耐药性与同源性分析
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摘要
目的了解内蒙古自治区12所三级甲等医院重症监护病房(ICU)临床标本及环境标本中耐甲氧西林金黄色葡萄球菌(MRSA)的耐药性及分子分型。方法收集2018年1月-2018年5月12所ICU患者标本中的MRSA,及同期ICU环境标本中分离的MRSA,对该菌株的研究通过耐药性分析及脉冲场凝胶电泳(PFGE)分型。结果 12所ICU的患者共检出47株MRSA,标本来源以痰为主,22株占46.81%,其次为血14株占29.79%,其他11株占23.40%;未发现MRSA对替加环素、万古霉素、呋喃妥因和利奈唑胺四种抗菌药物耐药,对奎奴普汀/达福普汀和复方新诺明的耐药率较低,分别为2.17%和14.89%,对其他抗菌药物的耐药率均>70%;从环境中分离出11株MRSA,其中床护栏检出3株,床头床尾表面和治疗台面分别检出2株,其他表面检出4株;从患者及环境中共保存到41株MRSA,对其进行PFGE同源性分析,由聚类分析可分为17(A-Q)个类型,无明显优势型别,以L型为主,7株占17.07%,其次为H型5株,Q型4株,K型3株;其余型别则仅含1～2株菌。结论对MRSA的PFGE聚类分析中看出从患者及其周围环境中检出同一种MRSA,应加强环境卫生的清洁、消毒与手卫生管理,避免发生感染暴发。
OBJECTIVE To understand the drug resistance and molecular typing of methicillin-resistant Staphylococcus aureus(MRSA)in clinical and environmental specimens from Intensive Care Unit(ICU)of 12 Grade III Class A hospitals in Inner Mongolia Autonomous Region.METHODS MRSA strains were collected from patients and environmental samples in ICU of 12 hospitals from Jan.to May 2018 for drug resistance analysis and pulsed field gel electrophoresis(PFGE)typing.RESULTS A total of 47 strains of MRSA were detected from the patients in the 12 ICUs,of which 22(46.81%)were from sputum,14(29.79%)were from blood and 11(23.40%)were from others.No resistance of MRSA to tigacycline,vancomycin,furantoin and linezolid was found.The resistance rates of MRSA strains to quinoluprine/dapeptin and compound xinomine were 2.17% and 14.89%,while the resistance rates for other antibiotics were all above 70%.A total of 11 MRSA strains were isolated from the environment in ICU,3 strains were detected in the bed fence,2 strains were detected on the surface of the bed ends and the treatment table respectively,and 1 strain each was detected from other sites.A total of 41 MRSA strains were preserved from the patients and the environment in ICU.PFGE homology analysis showed that there were 17(AQ)types by cluster analysis,with no obvious dominant type.The type of MRSA with largest number was type L with 7 strains(17.07%),followed by type H(5 strains),type Q(4 strains),type K(3 strains),and the remaining types only contained 1-2 strains.CONCLUSION The PFGE cluster analysis of MRSA showed that the same MRSA was detected from the patients and their surroundings.The control system of nosocomial infection should be strictly enforced,the infected patients should be isolated,and the sanitation and disinfection of the environment should be strengthened to avoid the outbreak of infection.
OBJECTIVE To understand the drug resistance and molecular typing of methicillin-resistant Staphylococcus aureus(MRSA)in clinical and environmental specimens from Intensive Care Unit(ICU)of 12 Grade III Class A hospitals in Inner Mongolia Autonomous Region.METHODS MRSA strains were collected from patients and environmental samples in ICU of 12 hospitals from Jan.to May 2018 for drug resistance analysis and pulsed field gel electrophoresis(PFGE)typing.RESULTS A total of 47 strains of MRSA were detected from the patients in the 12 ICUs,of which 22(46.81%)were from sputum,14(29.79%)were from blood and 11(23.40%)were from others.No resistance of MRSA to tigacycline,vancomycin,furantoin and linezolid was found.The resistance rates of MRSA strains to quinoluprine/dapeptin and compound xinomine were 2.17% and 14.89%,while the resistance rates for other antibiotics were all above 70%.A total of 11 MRSA strains were isolated from the environment in ICU,3 strains were detected in the bed fence,2 strains were detected on the surface of the bed ends and the treatment table respectively,and 1 strain each was detected from other sites.A total of 41 MRSA strains were preserved from the patients and the environment in ICU.PFGE homology analysis showed that there were 17(AQ)types by cluster analysis,with no obvious dominant type.The type of MRSA with largest number was type L with 7 strains(17.07%),followed by type H(5 strains),type Q(4 strains),type K(3 strains),and the remaining types only contained 1-2 strains.CONCLUSION The PFGE cluster analysis of MRSA showed that the same MRSA was detected from the patients and their surroundings.The control system of nosocomial infection should be strictly enforced,the infected patients should be isolated,and the sanitation and disinfection of the environment should be strengthened to avoid the outbreak of infection.
引文
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[10]江唯波,蒋泓宇,应晟,等.金黄色葡萄球菌医院感染和社区感染分布及耐药性对比分析[J].中华医院感染学杂志,2018,28(21):3211-3214.
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[13]Nimdet K,Techakehakij W.Congestive heart failure in children with pneumonia and respiratory failure.[J].Pediatr Int,2017,59(3):258-264.
[14]吴丹丹.甲氧西林耐药金黄色葡萄球菌分子分型、耐药机制及适应性代价研究[D].浙江大学,2018.
[15]谢金兰,姚惠,秦颖,等.2013-2017年ICU血培养病原菌分布及耐药趋势分析[J].中华医院感染学杂志,2018,28(8):1144-1147,1153.
[16]赵烁,付强.中国基层医疗机构医院感染管理现状及对策[J].中华医院感染学杂志,2017,27(24):5699-5703.
[17]Li QF,Xu H,Ni XP,et al.Impact of relocation and environmental cleaning on reducing the incidence of healthcareassociated infection in NICU[J].World J Pediatr,2017,13(3):217-221.
[18]卢岩,张秀月,张智洁,等.从ICU病房MRSA和CRAB的连续5年监测数据看不同多重耐药菌应有不同的防控策略[J].中国微生态学杂志,2015,27(10):1163-1166,1173.
[19]李艳萌,赵瑞珂,黄宝丽,等.医院获得性耐甲氧西林金黄色葡萄球菌Spa和SCCmec分型研究[J].重庆医学,2015,44(34):4821-4824.
[20]缪玉秀,高焕新,许蜜.精益管理在多重耐药菌医院感染预防与控制中的应用研究[J].实用临床医药杂志,2017,21(19):207-209.
[2]赵德军,胡昭宇,曹雁,等.重症监护病房患者耐甲氧西林金黄色葡萄球菌感染及耐药性研究[J].中国消毒学杂志,2014,31(8):835-837,840.
[3]吴珍,王莉洁,喻航,等.耐甲氧西林与甲氧西林敏感金黄色葡萄球菌血流感染的临床特征与耐药性分析[J].解放军医学院学报,2016,37(12):1241-1244.
[4]范陈良,李小四,吴晓燕.皮肤及软组织感染中金黄色葡萄球菌临床分布和耐药特性分析[J].中国抗菌药物杂志,2017,42(5):413-417.
[5]Hassoun A,Linden PK,Friedman B.Incidence,prevalence,and management of MRSA bacteremia across patient populations-a review of recent developments in MRSA management and treatment[J].Crit Care,2017,21(1):211.
[6]Choo EJ,Chambers HF.Treatment of methicillin-resistant Staphylococcus aureus bacteremia[J].Infect Chemother,2016,48(4):267-273.
[7]中华人民共和国卫生部.医院感染诊断标准(试行)[J].中华医学杂志,2001,81(5):314-320.
[8]Clinical and Laboratory Standards Institute.Performance ther,September.2017,Vol.17,No.standards for antimicrobial susceptibility testing[S].Twenty-sixth informational supplement,2016,M100S,26th Edition.
[9]Tenover FC,Arbeit RD,Goering RV,et al.Interpreting chromosomal DNA restriction patterns produced by pulsedfield gel electrophoresis:criteria for bacterial strain typing.[J].J Clin Microbiol.1995,33(9):2233-2239.
[10]江唯波,蒋泓宇,应晟,等.金黄色葡萄球菌医院感染和社区感染分布及耐药性对比分析[J].中华医院感染学杂志,2018,28(21):3211-3214.
[11]Tong SY,Davis JS,Eichenberger E,et al.Staphylococcus aureus infections:epidemiology,pathophysiology,clinical manifestations,and management.[J].Clin Microbiol Rev,2015,28(3):603-661.
[12]汪复,朱德妹,胡付品,等.2012年中国CHINET细菌耐药性监测[J].中国感染与化疗杂志,2009,9(5):321-329.
[13]Nimdet K,Techakehakij W.Congestive heart failure in children with pneumonia and respiratory failure.[J].Pediatr Int,2017,59(3):258-264.
[14]吴丹丹.甲氧西林耐药金黄色葡萄球菌分子分型、耐药机制及适应性代价研究[D].浙江大学,2018.
[15]谢金兰,姚惠,秦颖,等.2013-2017年ICU血培养病原菌分布及耐药趋势分析[J].中华医院感染学杂志,2018,28(8):1144-1147,1153.
[16]赵烁,付强.中国基层医疗机构医院感染管理现状及对策[J].中华医院感染学杂志,2017,27(24):5699-5703.
[17]Li QF,Xu H,Ni XP,et al.Impact of relocation and environmental cleaning on reducing the incidence of healthcareassociated infection in NICU[J].World J Pediatr,2017,13(3):217-221.
[18]卢岩,张秀月,张智洁,等.从ICU病房MRSA和CRAB的连续5年监测数据看不同多重耐药菌应有不同的防控策略[J].中国微生态学杂志,2015,27(10):1163-1166,1173.
[19]李艳萌,赵瑞珂,黄宝丽,等.医院获得性耐甲氧西林金黄色葡萄球菌Spa和SCCmec分型研究[J].重庆医学,2015,44(34):4821-4824.
[20]缪玉秀,高焕新,许蜜.精益管理在多重耐药菌医院感染预防与控制中的应用研究[J].实用临床医药杂志,2017,21(19):207-209.