HIV感染人群鼻腔携带的MRSA与MSSA菌株耐药谱及毒素基因分布特征

目的 探究广州市HIV感染人群鼻腔携带耐甲氧西林金黄色葡萄球菌(Methicillin - Resistant Staphylococcus aureus, MRSA)与甲氧西林敏感性葡萄球菌(Methicillin Sensitive Staphylococcus Aureus, MSSA)的耐药谱和毒素基因分布特征。方法 于2017年6 - 8月,便利抽取广州市某医院门诊就诊的1 001名HIV感染者并采集其鼻拭子样本,根据传统实验室方法分离鉴定出253株金黄色葡萄球菌,对鉴定出的菌株进行药物敏感性试验,利用头孢西丁纸片法和mecA扩增法鉴定MRSA,采用多重聚合酶链式反应(Polymerase Chain Reaction, PCR) 检测毒素基因。结果 253株SA菌株中,检出MRSA 119 (47.04%) 株,MSSA 134(52.96%)株。60.08%(152/253) 金黄色葡萄球菌为多重耐药SA(Multi - Drug Resistant, MDRSA)。 MRSA菌株和MSSA菌株耐药率最高的抗生素均为青霉素(89.08%,84.33%),其次为红霉素(61.34%, 53.73%)。MRSA菌株对头孢西丁、利福平、氯霉素、四环素和米诺环素的耐药率高于MSSA菌株,差异具有统计学意义。MRSA菌株毒素基因pvl和tst检出率均为4.20%,未检出eta和etb。MSSA菌株毒素基因pvl、tst、eta和etb的检出率分别为2.99%、1.49%、2.24%和0.75%。结论 HIV感染人群鼻腔携带金黄色葡萄球菌中的MRSA和MDRSA检出率高,但MRSA和MSSA菌株pvl、 tst、eta和etb检出率低。     

骨科分离80株金黄色葡萄球菌的mecA基因检测及耐药性分析

目的分析骨科分离的80株金黄色葡萄球菌耐药性,检测金黄色葡萄球菌的mecA基因,探讨金黄色葡萄球菌的耐药机制,指导临床合理应用抗菌药物。方法对2007年1月-2010年12月骨科患者分离的80株金黄色葡萄球菌进行耐药性分析,采用PCR检测金黄色葡萄球菌的mecA基因。结果检出的80株金黄色葡萄球菌中,体外药物敏感性试验发现,均对万古霉素、利奈唑胺敏感率为100.0%,而对青霉素、红霉素等敏感性较低,其中有46株耐甲氧西林金黄色葡萄球菌(MRSA),阳性率达到57.5%,采用PCR方法检测发现46株MRSA携带mecA基因,而对34株甲氧西林敏感金黄色葡萄球菌(MSSA)检测,发现有5株携带mecA基因。结论骨科MRSA分离率较高,而且均具有较高的耐药性,并且mecA基因PCR检测阳性与耐头孢西丁金黄色葡萄球菌的临床意义基本一致。     

社区糖尿病人群携带金黄色葡萄球菌的 分型与耐药谱关系研究

摘要:目的　了解社区糖尿病人群携带金黄色葡萄球菌的分型情况并分析其耐药谱。方法　随机抽取佛山市里水镇11个社区糖尿病人438名并收集其鼻拭子样本,根据传统实验室方法分离鉴定金黄色葡萄球菌,采用头孢西丁纸片扩散法和mecA基因扩增法进行耐甲氧西林金黄色葡萄球菌（Methicillin-Resistant Staphylococcus Aureus,MRSA）的鉴定,利用多重聚合酶链式反应（Polymerase Chain Reaction,PCR）的方法对MRSA菌株进行葡萄球菌染色体盒（Staphyloccoccal Cassette Chromosome mec,SCCmec）的分子分型,应用K-B纸片扩散法分析金黄色葡萄球菌的耐药谱。结果　438份样本中分离出43株金黄色葡萄球菌,检出率为9.82%,其中22株（5.02%）为MRSA。22株MRSA中,医院获得性耐甲氧西林金黄色葡萄球菌（Hospital-Acquired MRSA,HA-MRSA）7株,社区获得性耐甲氧西林金黄色葡萄球菌（Community-Acquired MRSA,CA-MRSA）10株,SCCmec未分型5株。金黄色葡萄球菌除对替考拉宁无耐药外,对其他抗生素均有不同程度的耐药,MRSA的耐药率普遍高于甲氧西林敏感金黄色葡萄球菌（Methicillin Sensitive Staphylococcus Aureus,MSSA）的耐药率,两者对红霉素和克林霉素耐药率差异有统计学意义,36.36%（8/22）的MRSA具有多重耐药性,MSSA中未发现多重耐药菌株。结论　该地区糖尿病人群携带的金黄色葡萄球菌中MRSA比例高,所携带的MRSA中以CA-MRSA为主,MRSA对抗生素的多重耐药问题值得重视。     

大学生鼻腔金黄色葡萄球菌带菌状况及药敏检测

目的调查正常人鼻腔金黄色葡萄球菌的带菌状况及检出菌株的药物敏感性。方法高盐甘露醇选择培养基分离培养法,并对分离出的金黄色葡萄球菌进行药物敏感性检测。结果在202名正常人鼻腔中,共检出金黄色葡萄球菌53株,带菌率为26.24％。对12种抗菌药物的敏感性试验结果显示:检出菌株对头孢氨苄和头孢唑啉敏感性最高,为88％,而对青霉素、氨苄青霉素和红霉素的耐药性最高,均已超过60％。结论正常人鼻腔金黄色葡萄球菌带菌率较高,且耐药性广泛。     

煤工尘肺下呼吸道耐甲氧西林金黄色葡萄球菌mecA基因检测及其耐药性

目的 检测煤工尘肺下呼吸道感染耐甲氧西林金黄色葡萄球菌(MRSA)的mecA基因及菌株的耐药特点.方法 对从49例尘肺患者下呼吸道中分离的56株金黄色葡萄球菌通过苯唑西林筛选实验确定可疑菌株39株,采用聚合酶链反应(PCR)检测mecA基因;观察:MRSA对抗生素的耐药性.结果 56株金黄色葡萄球菌中mecA基因阳性菌株37株,MRSA阳性率为66.1%;煤工尘肺患者的MRSA对青霉素、苯唑青霉素、复方磺胺的耐药性为100%,对红霉素、四环素、头孢曲松、头孢唑林的耐药性为83.0%以上,为多重耐药性.煤工尘肺金黄色葡萄球菌对青霉素、苯唑青霉素、红霉素、环丙沙星、头孢唑林、头孢曲松、复方磺胺的耐药率明显高于非尘肺患者,差异有统计学意义(P＜0.05或P＜0.01).结论 检测mecA基因是确定MRSA的准确方法;煤工尘肺患者的MRSA耐药性较高,为多重耐药性.     

慢性鼻-鼻窦炎患者鼻腔分泌物金黄色葡萄球菌分离株耐药性及毒力基因

目的 探究慢性鼻-鼻窦炎(CRS)患者鼻腔分泌物分离金黄色葡萄球菌的耐药特点及毒力基因。方法 收集2020年8月-2021年8月上海市第六人民医院南院诊治的104例CRS患者鼻拭子分离的金黄色葡萄球菌55株,分析其对常用抗菌药物的耐药率,多位点序列分型(MLST)及其毒力基因。结果 55株金黄色葡萄球菌检出耐甲氧西林金黄色葡萄球菌(MRSA)16株占29.09%,检出甲氧西林敏感金黄色葡萄球菌(MSSA)39株占70.91%; MRSA菌株对红霉素、利福平、环丙沙星、庆大霉素、左氧氟沙星、四环素、莫西沙星的耐药率显著高于MSSA菌株(P<0.05); 55株金黄色葡萄球菌有46株成功进行分型,其中MRSA检出8种ST型,以ST59为主,MSSA检出12种ST型,以ST6、ST72为主;MRSA菌株毒力基因seb、tsst-1、hlα、hlbβ、sdrC、sdrD、sdrE检出率显著高于MSSA菌株(P<0.05)。结论 CRS患者鼻腔分泌物分离金黄色葡萄球菌对利奈唑胺、呋喃妥因、替加环素、替考拉宁、万古霉素敏感,其中MRSA主要流行型别为ST59,hlα、fnbpA、clf...     

健康儿童鼻携带金黄色葡萄球菌耐药性研究

摘要:目的　探讨广州在校健康儿童金黄色葡萄球菌鼻携带率及该菌对常见抗生素的耐药性。方法　广州市荔湾区抽取1间幼儿园和1间小学,对纳入研究对象采集鼻拭子进行金黄色葡萄球菌分离鉴定,并对阳性菌株进行抗生素药物敏感性检测。结果　共纳入463名幼儿园儿童及1 012名小学生,小学生金黄色葡萄球菌鼻携带率（40.1%）比幼儿园儿童（31.1%）高,其差异有统计学意义（χ2＝11.05,P＜0.05）。药敏结果显示,耐甲氧西林金黄色葡萄球菌（Methicillin-Resistant Staphylococcus Aureus,MRSA）呈多药耐药状态,其对四环素、红霉素及克林霉素的耐药率远高于甲氧西林敏感金黄色葡萄球菌（Methicillin-Sensitive Staphylococcus Aureus,MSSA）,差异有统计学意义（P值均＜0.05）。结论　广州荔湾区在校健康儿童鼻携带金黄色葡萄球菌较高,健康儿童鼻携带金黄色葡萄球菌高耐青霉素、红霉素及克林霉素。建议开展全国性监测,为临床医生合理用药提供参考依据。     

新生儿携带MRSA和MSSA的现状及其耐药谱分析

  目的  了解新生儿耐甲氧西林金黄色葡萄球菌（methicillin-resistant staphylococcus aureus,MRSA）和甲氧西林敏感金黄色葡萄球菌（methicillin-sensitive staphylococcus aureus,MSSA）的携带现状及其耐药情况。  方法  采用横断面研究,于2015年8月-11月,对深圳市龙华区人民医院和观澜医院的1 834名新生儿进行棉拭子采样、菌株分离鉴定及药物敏感试验。  结果  新生儿金黄色葡萄球菌（staphylococcus aureus,SA）、MRSA、MSSA的携带率分别为3.27%（60/1 834）、0.82%（15/1 834）、2.45%（45/1 834）。MRSA与MSSA对青霉素、红霉素的耐药率较高,对利奈唑胺的耐药率均小于10%。MRSA对红霉素、莫西沙星、克林霉素的耐药率均高于MSSA（均有P < 0.05）;MRSA的多重耐药率高达80.00%,风险是MSSA的12.36倍。  结论  该地区新生儿SA尤其是MRSA多重耐药率较高,且MRSA耐药情况比MSSA更严重。     

矽肺患者金黄色葡萄球菌的临床耐药性分析

目的了解金黄色葡萄球菌对矽肺患者临床常用抗菌药物的耐药情况,为临床合理用药提供参考。方法对各类感染标本分离的62株金黄色葡萄球菌,采用K-B纸片琼脂扩散法进行药敏试验;头孢西丁纸片扩散法筛选耐甲氧西林金黄色葡萄球菌(MRSA)。结果头孢西丁纸片扩散法共检出37株(59.7%)MRSA。MRSA对β内酰胺类抗生素耐药率较高,对青霉素、头孢西丁、头孢曲松、氨苄西林耐药率均达100%;MRSA和甲氧西林敏感金黄色葡萄球菌(MSSA)对大环内酯类、磺胺类抗生素均有不同程度耐药;复方新诺明对MRSA菌的敏感率比MSSA强得多,MRSA对其的敏感率达78.4%,MSSA对其的敏感率仅达8%;MRSA对红霉素的耐药率极高,达97.3%;MRSA和MSSA对万古霉素的敏感率均为100%。MRSA检出率为59.7%。结论临床分离的金黄色葡萄球菌对常用抗菌药物多重耐药,应根据分离株耐药特点选用不同的治疗方案;头孢西丁纸片扩散法筛选MRSA效果较好。     

皮肤及软组织化脓性金黄色葡萄球菌感染的耐药谱分析

目的调查引起皮肤和软组织化脓性感染金黄色葡萄球菌的耐药性。方法应用VITEK-60全自动微生物分析仪进行药敏试验,对其耐药谱情况及临床特点进行分析。结果分离得到引起皮肤软组织化脓性感染金黄色葡萄球菌76株,其中耐甲氧西林金黄色葡萄球菌(MRSA)43株,占56.6%;在MRSA中,对青霉素、氨苄西林的耐药率为100.0%,红霉素为95.3%;在MSSA中对3种药物的耐药率分别为97.0%、54.5%、60.6%,对已做呋喃妥因药敏检测的菌株均为敏感株,未检到耐药菌株及中介菌株,万古霉素的耐药率均为0,亦未检到中介菌株。结论引起皮肤和软组织化脓性感染的金黄色葡萄球菌,对多种抗菌药物耐药率较高,大部分MRSA为多药耐药菌株,临床应长期进行耐药性监测。     

成都社区健康儿童携带金黄色葡萄球菌耐药性分析

目的了解成都市部分在校健康儿童鼻前庭金黄色葡萄球菌携带及药物敏感情况。方法收集成都市部分中小学及幼儿园健康儿童鼻前庭拭子,培养并分离金葡菌,同时应用纸片扩散法进行青霉素、红霉素、克林霉素、头孢西丁及万古霉素药敏试验。结果从1416份标本中分离出金葡菌257例,阳性率为18.15%,青霉素耐药率高达89.11%,耐甲氧西林金黄色葡萄球菌(MRSA)占4.28%,未发现耐万古霉素的金葡菌。结论成都在校健康儿童鼻前庭金葡菌携带率较高且对常用抗生素具有较高耐药率。     

Susceptibility patterns of Staphylococcus in a family practice population.

Nasal swabs were obtained from 408 patients seen in a family practice office in an attempt to identify Staphylococcus aureus carriers. Isolated strains were tested for sensitivity to 11 antibiotics. Study participants were interviewed to obtain the following data: age, history of recent hospitalization and/or recent antibiotic use, number of household members, and occupation, if employed in a health-care facility. S aureus was isolated from 109 nasal swabs. This represents a 26.7 percent carrier rate. Only 25.7 percent of the isolates were sensitive to penicillin G and ampicillin. No statistically significant association was found between the patient variables and either the carrier rate or the sensitivity of the S aureus isolates to penicillin. The sensitivity testing demonstrated that 94.5 percent of the isolates were sensitive to tetracycline and erythromycin. Ninety-nine to 100 percent of the isolates were sensitive to all other antibiotics tested. The authors conclude that penicillin G should not be used in the treatment of S aureus infections. Erythromycin, due to demonstrated sensitivity and reasonable cost, is recommended for mild to moderate infections.     

广东省人群多重耐药金葡菌的携带及耐药性分析

目的 调查广东省部分人群(动物从业人员和一般人群)的多重耐药金葡菌(multidrug-resistant S.aureus,MDRSA)携带情况,并分析菌株的耐药性.方法 对研究对象进行问卷调查和鼻拭子采样,对金葡菌进行药敏试验,分析方法采用x2检验.结果 动物从业人员中金葡菌、MDRSA、甲氧西林耐药金葡菌(methicillin-resistantS.aureus,MRSA)的携带率均高于对照人群(分别为13.3％ vs9.3％;9.5％ vs 3.4％;7.0％ vs 1.4％;均有P＜0.01).金葡菌对青霉素、克林霉素、四环素和红霉素的耐药率较高,MDRSA主要耐药模式是同时对克林霉素、红霉素、四环素耐药.除了青霉素外,动物从业人员金葡菌对各类抗生素的耐药率均高于对照人群;MRSA菌株对各类抗生素的耐药率均高于甲氧西林敏感金葡菌.结论 本研究提示职业性动物接触可能导致从业人员感染耐药细菌.     

广州市小学生携带甲氧西林耐药与多重耐药金葡菌的耐药性分析

目的 掌握小学生金黄色葡萄球菌（金葡菌）的携带率，并探究菌株的抗生素耐药性。方法 对广州市部分在校健康小学生进行鼻拭子采样，对分离的金葡菌进行抗生素药敏试验。结果 1 012名小学生中金葡菌的携带率为40.1%，耐甲氧西林金葡菌的携带率为1.2%，多重耐药金葡菌的携带率为4.0%。金葡菌主要对青霉素、红霉素和克林霉素耐药；多重耐药金葡菌的主要耐药谱为同时对红霉素、克林霉素及四环素耐药和同时对红霉素、克林霉素及头孢西丁耐药。多因子降维法结果显示多重耐药金葡菌对头孢西丁、四环素和氯霉素同时耐药的比例是非多重耐药金葡菌的104.39倍。结论 广州市健康小学生金葡菌的携带率较高，呈现出多重耐药状态，为指导社区儿童合理使用抗生素提供数据支持。     

Staphylococcus aureus rectal carriage and its association with infections in patients in a surgical intensive care unit and a liver transplant unit.

BACKGROUND: The role of rectal carriage of Staphylococcus aureus as a risk factor for nosocomial S. aureus infections in critically ill patients has not been fully discerned. METHODS: Nasal and rectal swabs for S. aureus were obtained on admission and weekly thereafter until discharge or death from 204 consecutive patients admitted to the surgical intensive care unit and liver transplant unit RESULTS: Overall, 49.5% (101 of 204) of the patients never harbored S. aureus, 21.6% (44 of 204) were nasal carriers only, 3.4% (7 of 204) were rectal carriers only, and 25.5% (52 of 204) were both nasal and rectal carriers. Infections due to S. aureus developed in 15.7% (32 of 204) of the patients; these included 3% (3 of 101) of the non-carriers, 18.2% (8 of 44) of the nasal carriers only, 0% (0 of 7) of the rectal carriers only, and 40.4% (21 of 52) of the patients who were both nasal and rectal carriers (P - .001). Patients with both rectal and nasal carriage were significantly more likely to develop S. aureus infection than were those with nasal carriage only (odds ratio, 3.9; 95% confidence interval, 1.18 to 7.85; P= .025). By pulsed-field gel electrophoresis, the infecting rectal and nasal isolates were clonally identical in 82% (14 of 17) of the patients with S. aureus infections. CONCLUSIONS: Rectal carriage represents an underappreciated reservoir for S. aureus in patients in the intensive care unit and liver transplant recipients. Rectal plus nasal carriage may portend a greater risk for S. aureus infections in these patients than currently realized.     

Nasal carriage of S. aureus increases the risk of surgical site infection after major heart surgery

Staphylococcus aureus is the main cause of surgical site infection (SSI) after major heart surgery (MHS), with the patient's endogenous flora as the principal source. However, the influence of nasal carriage of S. aureus on the development of SSI after MHS has not been established and Centers for Disease Control and Prevention guidelines do not make a recommendation for or against decolonisation. We performed a one-year observational study in which patients undergoing MHS were screened for nasal carriage of S. aureus before surgery. Cases of SSI were recorded and the risk factors of patients with and without SSI were analysed. During the study period, 357 patients were included in the protocol. Ninety-six patients (27%) were found to be nasal carriers of S. aureus and nine (9.4%) of these had meticillin-resistant (MRSA) strains. The overall incidence of SSI was 6.4%, with 4.2% for mediastinitis and 2.2% for superficial SSI. Nasal carriers of S. aureus had a significantly higher incidence of SSI than non-carriers (12.5% vs 5%, P=0.01). Among MRSA carriers, the incidence of SSI reached 33% (P<0.001). S. aureus was responsible for 64% of SSIs. Multivariate analysis showed that the independent factors for SSI were S. aureus nasal carriage [relative risk (RR): 3.1; 95% confidence interval (CI): 1.4-7.3; P=0.009], reoperation (RR: 3.1; 95% CI: 1.8-19.2; P=0.04) and diabetes mellitus (RR: 5.9; 95% CI: 1.8-19.2; P=0.003). Nasal carriage of S. aureus significantly increases the rate of nosocomial SSI after MHS and decolonisation strategies should be implemented in this population.     

Prevalence and determinants of nasal colonization with antibiotic-resistant Staphylococcus aureus among unselected patients attending general practitioners in Germany

Although the great majority of antibiotics are prescribed outside hospitals, little is known about the prevalence and determinants of antibiotic resistance in the group of outpatients. Nasal swabs were taken from 627 consecutive patients aged 40 years or above attending general practitioners in Southern Germany. Staphylococcus aureus was cultured and minimal inhibitory concentrations to various antibiotics were tested. Nasal swabs of 152 patients were positive for S. aureus. Prevalence of resistance was 68.3, 8.3 and 0.7% for penicillin G, erythromycin, and oxacillin respectively. Antibiotic use within the last month was associated with erythromycin resistance [adjusted odds ratio (OR) 7.4; 95 % confidence interval (CI) 1.0-53]. Besides a high prevalence of resistance to penicillinase-instable antibiotics we found only one (0.7%) methicillin-resistant S. aureus. Recent antibiotic use was associated with increased resistance to erythromycin.     

幼儿园儿童携带金黄色葡萄球菌及其影响因素分析

目的 了解幼儿园儿童金黄色葡萄球菌(金葡菌)的携带状况及其影响因素.方法本研究采用多阶段分层整群抽样方法,抽取柳州市六所幼儿园的1 702名健康儿童,进行鼻拭子采样并分离鉴定金葡菌.各组金葡菌携带率的比较采用x2检验,金葡菌携带影响因素的多因素分析采用Logistic回归分析模型.结果 儿童鼻腔金葡菌携带率为16.27...     

The relationship between hand hygiene practices and nasal Staphylococcus aureus carriage in healthcare workers

Background:The nasal carriage rate of Staphylococcus aureus in healthcare workers (HCWs) is higher than the general population. Their hands serve as vectors for transmitting S.aureus colonized in the nose to patients.Objectives:To determine the rate of nasal S.aureus carriage and methicillin resistance in HCWs and to evaluate the relationship between carriage and personal risk factors and hand hygiene behaviors.Methods:The questionnaire included questions about sociodemographic characteristics, occupational and personal risk factors for S.aureus carriage, the “Hand Hygiene Belief Scale (HHBS),” and “Hand Hygiene Practices Inventory (HHPI)”. Nasal culture was taken from all participants. Presence of S.aureus, methicillin and mupirocin resistance were investigated in samples.Results:The study was carried out with 269 HCWs. The prevalence of S.aureus carriage was 20.1% (n:54). Among 54 S.aureus carriers, only one person had MRSA (0.37%). All S.aureus isolates were susceptible to mupirocin. S.aureus carriage was found to be significantly lower in the smoker group (p:0.015) and in the personnel wearing gloves during the procedures of each patient (p:0.002). S.aureus culture positivity was found to decrease significantly with increasing handwashing frequency (p:0.003). The mean HHPI score was higher in women (p:0.001). The mean HHPI score was lower in the group with nasal carriers than in non-carriers (p:0.176).Conclusion:The knowledge of hand hygiene practices, high frequency of handwashing, and wearing different gloves during the procedure of each patient decrease S.aureus nasal carriage in HCWs. In addition mupirocin is still effective in nasal S.aureus carriers.Key words: Staphylococcus aureus, nasal carriage, hand hygiene practices