耐甲氧西林金黄色葡萄球菌对莫匹罗星、夫西地酸和瑞他莫林的耐药性分析
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摘要
目的分析耐甲氧西林金黄色葡萄球菌(MRSA)临床菌株对局部抗菌药物莫匹罗星、夫西地酸和瑞他莫林的耐药情况。方法收集临床分离的1 037株MRSA,用微量肉汤稀释法测定其对莫匹罗星、夫西地酸和瑞他莫林的最小抑菌浓度(MIC),筛选对3种抗菌药物耐药的菌株,用Vitek 2 Compact全自动微生物分析系统检测耐莫匹罗星、夫西地酸和瑞他莫林菌株对其他临床常用抗菌药物的耐药性。结果1037株MRSA中,有54株对莫匹罗星耐药(5.2%),且以高水平耐药(MuH)为主(85.2%);9株(0.9%)对夫西地酸耐药的MRSA菌株以低水平耐药(FAL)居多(77.8%);仅2株(0.2%)对瑞他莫林耐药。对3种抗菌药物耐药的MRSA对氨基糖苷类、大环内酯类、林可酰胺类及氟喹诺酮类等临床常用抗菌药物也表现出较高的耐药率。结论临床分离的MRSA对莫匹罗星、夫西地酸、瑞他莫林等局部抗菌药物具有较低的耐药率,但少量耐药菌株的存在提示应加强金黄色葡萄球菌对该类药物的耐药性监测工作。
Objective To investigate the drug resistance of methicillin-resistant Staphylococcus aureus(MRSA) to mupirocin,fusidic acid and retapamulin. Methods A total of 1 037 MRSA isolates were collected. The minimum inhibitory concentrations(MIC) of mupirocin,fusidic acid and retapamulin were determined by microbroth dilution method. The isolates resistant to 3 antibiotics were screened. The drug resistance of MRSA to mupirocin,fusidic acid and retapamulin was determined by Vitek 2 Compact analyzer. Results Among the 1 037 MRSA isolates,54(5.2%) MRSA isolates were resistant to mupirocin,and 85.2% of them were high-level mupirocin resistance(MuH). Among 9(0.9%) fusidic acid resistant MRSA isolates,77.8% of them were low-level fusidic acid resistance(FAL). The proportion of retapamulin resistant MRSA isolates was the lowest(0.2%). The MRSA isolates,which were resistant to mupirocin,fusidic acid and retapamulin,were also highly resistant to aminoglycosides,macrolides,lincosamides and fluoroquinolones. Conclusions Low mupirocin,fusidic acid and retapamulin resistance in MRSA isolates is found. The existence of a small amount of drug resistant isolates suggests that it should strengthen the determination and surveillance of the drug resistance of Staphylococcus aureus.
Objective To investigate the drug resistance of methicillin-resistant Staphylococcus aureus(MRSA) to mupirocin,fusidic acid and retapamulin. Methods A total of 1 037 MRSA isolates were collected. The minimum inhibitory concentrations(MIC) of mupirocin,fusidic acid and retapamulin were determined by microbroth dilution method. The isolates resistant to 3 antibiotics were screened. The drug resistance of MRSA to mupirocin,fusidic acid and retapamulin was determined by Vitek 2 Compact analyzer. Results Among the 1 037 MRSA isolates,54(5.2%) MRSA isolates were resistant to mupirocin,and 85.2% of them were high-level mupirocin resistance(MuH). Among 9(0.9%) fusidic acid resistant MRSA isolates,77.8% of them were low-level fusidic acid resistance(FAL). The proportion of retapamulin resistant MRSA isolates was the lowest(0.2%). The MRSA isolates,which were resistant to mupirocin,fusidic acid and retapamulin,were also highly resistant to aminoglycosides,macrolides,lincosamides and fluoroquinolones. Conclusions Low mupirocin,fusidic acid and retapamulin resistance in MRSA isolates is found. The existence of a small amount of drug resistant isolates suggests that it should strengthen the determination and surveillance of the drug resistance of Staphylococcus aureus.
引文
[1]HETEM D J,BONTEN M J.Clinical relevance of mupirocin resistance in Staphylococcus aureus[J].J Hosp Infect,2013,85(4):249-256.
[2]MCNEIL J C,HULTEN K G,KAPLAN S L,et al.Decreased susceptibilities to retapamulin,mupirocin,and chlorhexidine among Staphylococcus aureus isolates causing skin and soft tissue infections in otherwise healthy children[J].Antimicrob Agents Chemother,2014,58(5):2878-2883.
[3]YU F,LIU Y,LU C,et al.Dissemination of fusidic acid resistance among Staphylococcus aureus clinical isolates[J].BMC Microbiol,2015,15:210.
[4]尚红,王毓三,申子瑜.全国临床检验操作规程[M].4版.北京:人民卫生出版社,2015:749.
[5]Clinical and Laboratory Standards Institute.Performance standards for antimicrobial susceptibility testing[S].M100-S26,CLSI,2016.
[6]LIU Q Z,WU Q,ZHANG Y B,et al.Prevalence of clinical meticillin-resistant Staphylococcus aureus(MRSA)with high-level mupirocin resistance in Shanghai and Wenzhou,China[J].Int J Antimicrob Agents,2010,35(2):114-118.
[7]TRACZEWSKI M M,BROWN S D.Proposed MICand disk diffusion microbiological cutoffs and spectrum of activity of retapamulin,a novel topical antimicrobial agent[J].Antimicrob Agents Chemother,2008,52(11):3863-3867.
[8]SEPTIMUS E J,SCHWEIZER M L.Decolonization in prevention of health care-associated infections[J].Clin Microbiol Rev,2016,29(2):201-222.
[9]NAGANT C,DEPLANO A,NONHOFF C,et al.Low prevalence of mupirocin resistance in Belgian Staphylococcus aureus isolates collected during a 10 year nationwide surveillance[J].J Antimicrob Chemother,2016,71(1):266-267.
[10]严明,吴建国,黄文祥,等.金黄色葡萄球菌对莫匹罗星和氯己定的耐药研究进展[J].中国感染与化疗杂志,2016,16(4):506-509.
[11]HETEM D J,BONTEN M J.Clinical relevance of mupirocin resistance in Staphylococcus aureus[J].J Hosp Infect,2013,85(4):249-256.
[12]YANG J A,PARK D W,SOHN J W,et al.Molecular analysis of isoleucyl-tRNA synthetase mutations in clinical isolates of methicillin-resistant Staphylococcus aureus with low-level mupirocin resistance[J].J Korean Med Sci,2006,21(5):827-832.
[13]陈舒影,林纯婵,卢超慧,等.金黄色葡萄球菌临床分离株对夫西地酸的耐药性分析[J].中国临床药理学杂志,2015,31(19):1971-1973.
[14]CHEN H J,HUNG W C,TSENG S P,et al.Fusidic acid resistance determinants in Staphylococcus aureus clinical isolates[J].Antimicrob Agents Chemother,2010,54(12):4985-4991.
[15]李耘,薛峰,刘健,等.夫西地酸体外抗菌活性研究[J].中国临床药理学杂志,2013,29(1):34-37.
[16]SARAVOLATZ L D,PAWLAK J,SARAVOLATZ S N,et al.In vitro activity of retapamulin against Staphylococcus aureus resistant to various antimicrobial agents[J].Antimicrob Agents Chemother,2013,57(9):4547-4550.
[17]PéREZ-TRALLERO E,TAMAYO E,MONTES M,et al.In vitro activities of retapamulin and 16 other antimicrobial agents against recently obtained Streptococcus pyogenes isolates[J].Antimicrob Agents Chemother,2011,55(5):2406-2408.
[18]HARRINGTON A T,BLACK J A,CLARRIDGE JE 3rd.In vitro activity of retapamulin and antimicrobial susceptibility patterns in a longitudinal collection of methicillin-resistant Staphylococcus aureus isolates from a veterans affairs medical center[J].Antimicrob Agents Chemother,2015,60(3):1298-1303.
[19]WOODFORD N,AFZAL-SHAH M,WARNER M,et al.In vitro activity of retapamulin against Staphylococcus aureus isolates resistant to fusidic acid and mupirocin[J].JAntimicrob Chemother,2008,62(4):766-768.
[2]MCNEIL J C,HULTEN K G,KAPLAN S L,et al.Decreased susceptibilities to retapamulin,mupirocin,and chlorhexidine among Staphylococcus aureus isolates causing skin and soft tissue infections in otherwise healthy children[J].Antimicrob Agents Chemother,2014,58(5):2878-2883.
[3]YU F,LIU Y,LU C,et al.Dissemination of fusidic acid resistance among Staphylococcus aureus clinical isolates[J].BMC Microbiol,2015,15:210.
[4]尚红,王毓三,申子瑜.全国临床检验操作规程[M].4版.北京:人民卫生出版社,2015:749.
[5]Clinical and Laboratory Standards Institute.Performance standards for antimicrobial susceptibility testing[S].M100-S26,CLSI,2016.
[6]LIU Q Z,WU Q,ZHANG Y B,et al.Prevalence of clinical meticillin-resistant Staphylococcus aureus(MRSA)with high-level mupirocin resistance in Shanghai and Wenzhou,China[J].Int J Antimicrob Agents,2010,35(2):114-118.
[7]TRACZEWSKI M M,BROWN S D.Proposed MICand disk diffusion microbiological cutoffs and spectrum of activity of retapamulin,a novel topical antimicrobial agent[J].Antimicrob Agents Chemother,2008,52(11):3863-3867.
[8]SEPTIMUS E J,SCHWEIZER M L.Decolonization in prevention of health care-associated infections[J].Clin Microbiol Rev,2016,29(2):201-222.
[9]NAGANT C,DEPLANO A,NONHOFF C,et al.Low prevalence of mupirocin resistance in Belgian Staphylococcus aureus isolates collected during a 10 year nationwide surveillance[J].J Antimicrob Chemother,2016,71(1):266-267.
[10]严明,吴建国,黄文祥,等.金黄色葡萄球菌对莫匹罗星和氯己定的耐药研究进展[J].中国感染与化疗杂志,2016,16(4):506-509.
[11]HETEM D J,BONTEN M J.Clinical relevance of mupirocin resistance in Staphylococcus aureus[J].J Hosp Infect,2013,85(4):249-256.
[12]YANG J A,PARK D W,SOHN J W,et al.Molecular analysis of isoleucyl-tRNA synthetase mutations in clinical isolates of methicillin-resistant Staphylococcus aureus with low-level mupirocin resistance[J].J Korean Med Sci,2006,21(5):827-832.
[13]陈舒影,林纯婵,卢超慧,等.金黄色葡萄球菌临床分离株对夫西地酸的耐药性分析[J].中国临床药理学杂志,2015,31(19):1971-1973.
[14]CHEN H J,HUNG W C,TSENG S P,et al.Fusidic acid resistance determinants in Staphylococcus aureus clinical isolates[J].Antimicrob Agents Chemother,2010,54(12):4985-4991.
[15]李耘,薛峰,刘健,等.夫西地酸体外抗菌活性研究[J].中国临床药理学杂志,2013,29(1):34-37.
[16]SARAVOLATZ L D,PAWLAK J,SARAVOLATZ S N,et al.In vitro activity of retapamulin against Staphylococcus aureus resistant to various antimicrobial agents[J].Antimicrob Agents Chemother,2013,57(9):4547-4550.
[17]PéREZ-TRALLERO E,TAMAYO E,MONTES M,et al.In vitro activities of retapamulin and 16 other antimicrobial agents against recently obtained Streptococcus pyogenes isolates[J].Antimicrob Agents Chemother,2011,55(5):2406-2408.
[18]HARRINGTON A T,BLACK J A,CLARRIDGE JE 3rd.In vitro activity of retapamulin and antimicrobial susceptibility patterns in a longitudinal collection of methicillin-resistant Staphylococcus aureus isolates from a veterans affairs medical center[J].Antimicrob Agents Chemother,2015,60(3):1298-1303.
[19]WOODFORD N,AFZAL-SHAH M,WARNER M,et al.In vitro activity of retapamulin against Staphylococcus aureus isolates resistant to fusidic acid and mupirocin[J].JAntimicrob Chemother,2008,62(4):766-768.