铜绿假单胞菌对左氧氟沙星耐药相关差异蛋白质组学研究

目的筛选铜绿假单胞菌野生型菌株PAO1对左氧氟沙星耐药前后的差异蛋白质,探讨这些蛋白质与铜绿假单胞菌对左氧氟沙星耐药的关系。方法采用亚抑菌浓度梯度递增法体外诱导PAO1对左氧氟沙星耐药,并设置同步对照组,应用表面增强激光解析电离飞行时间质谱(SELDI)技术和CM10蛋白质芯片检测PAO1对左氧氟沙星耐药株和同步对照菌株的菌体蛋白,采用Biomarker Wizard软件进行分析。结果左氧氟沙星耐药株与同步对照菌株间有8个差异蛋白(P<0.05),5个差异蛋白高表达,分子量分别为1 004、1 007、1 918、5 175Da和5 454Da;有3个蛋白质低表达,分子量分别为1 012、1 629、2 004Da。结论用蛋白质芯片和SELDI技术对PAO1的左氧氟沙星耐药菌株与同步对照菌株进行蛋白质组学研究,可以筛选出与PAO1对左氧氟沙星耐药可能相关的差异蛋白质。     

铜绿假单胞菌对左氧氟沙星耐药相关差异蛋白质组学研究北大核心CSCD

目的筛选铜绿假单胞菌野生型菌株PAO1对左氧氟沙星耐药前后的差异蛋白质,探讨这些蛋白质与铜绿假单胞菌对左氧氟沙星耐药的关系。方法采用亚抑菌浓度梯度递增法体外诱导PAO1对左氧氟沙星耐药,并设置同步对照组,应用表面增强激光解析电离飞行时间质谱(SELDI)技术和CM10蛋白质芯片检测PAO1对左氧氟沙星耐药株和同步对照菌株的菌体蛋白,采用Biomarker Wizard软件进行分析。结果左氧氟沙星耐药株与同步对照菌株间有8个差异蛋白(P<0.05),5个差异蛋白高表达,分子量分别为1 004、1 007、1 918、5 175Da和5 454Da;有3个蛋白质低表达,分子量分别为1 012、1 629、2 004Da。结论用蛋白质芯片和SELDI技术对PAO1的左氧氟沙星耐药菌株与同步对照菌株进行蛋白质组学研究,可以筛选出与PAO1对左氧氟沙星耐药可能相关的差异蛋白质。     

耐甲氧西林金黄色葡萄球菌对碘伏和氯已定抗性的研究

目的 了解临床分离的耐甲氧西林的金黄色葡萄球菌(MRSA)对医院常用消得剂的抗性。方法 测定碘伏和氯已定对MRSA、甲氧西林敏感的金黄色葡萄球菌(MSSA)和金鱼色葡萄球菌ATCC6538的最小抑菌浓度(MIC)。结果 碘伏对MRSA的MIC明显高于MSSA,在38株MRSA中5.3％菌株的MIC是质控菌株的2倍,28.95％菌株的MIC为质控菌株的1.5倍,而18株MSSA中仅有11.1％菌株的MIC是质控菌株的1.5倍,83.3％菌株的MIC值与质控菌株相同。醋酸氯已定对MRSA、MSSA和金黄色葡萄球菌ATCC6538的MIC值相同。结论 部分MRSA菌株对碘伏抗性增高,MRSA对氯已定的抗性无明显增强,因此当有抗性菌株存在时应提高碘伏的浓度     

耐甲氧西林金黄色葡萄球菌及肠毒素的检测

目的评价乳胶结合实验检测耐甲氧西林金黄色葡萄球菌(MRSA)的方法并检测MRSA的肠毒素.方法收集130株金黄色葡萄球菌临床分离株,通过药敏试验将其分为耐甲氧西林金黄色葡萄球菌和甲氧西林敏感金黄色葡萄球菌(MSSA),应用乳胶结合试验和基因扩增分别检测青霉素结合蛋白2a(PBP2a)和MecA基因;用酶联免疫吸附试验(ELISA)检测耐甲氧西林金黄色葡萄球菌肠毒素.结果65株MecA基因扩增阳性菌株中的62株PBP2a检测阳性,63株MSSA中,MecA基因扩增及PBP2a检测全部为阴性.MRSA产肠毒素为67株.MSSA肠毒素为19株.结论乳胶结合试验是一种简便、快速、准确检测MRSA的方法,实验室应重视金黄色葡萄球菌肠毒素的检测.     

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。     

金黄色葡萄球菌肠毒素基因的检测和耐药性分析

目的了解金黄色葡萄球菌(Staphylococcus aureus,SA)临床分离株的肠毒素基因携带情况和耐药现状。方法 PCR扩增SA肠毒素编码基因sea、seb、sec、sed、see和sef,电泳检测扩增结果。K-B法检测SA临床菌株对药物敏感性,头孢西丁法检测耐甲氧西林金黄色葡萄球菌(MRSA)。结果 89株临床菌株中,68株肠毒素基因阳性,阳性率为76.4%,sea、seb、sec、sed、see和sef检出率分别为58.4%、5.6%、43.8%、3.4%、2.2%和14.6%,36株(40.4%)同时检测到2种或2种以上肠毒素基因。MRSA和甲氧西林敏感金黄色葡萄球菌(MSSA)分别占42.7%(38/89)和57.3%(51/89),MRSA肠毒素基因携带率(92.1%,35/38)明显高于MSSA的携带率(64.7%,33/51),差异有统计学意义(P0.05)。金黄色葡萄球菌除对万古霉素、利奈唑胺和呋喃妥因敏感外,对青霉素、苯唑西林等9种抗菌药物均有耐药性,且MRSA的耐药性比MSSA的强。结论应重视对金黄色葡萄球菌肠毒素和MRSA的检测,合理使用抗菌药物,以利于医院MRSA感染的控制。     

5452株金黄色葡萄球菌临床分布及耐药性分析

目的比较甲氧西林敏感金黄色葡萄球菌(Methicillin Sensitive Staphylococcus Aureus,MSSA)与耐甲氧西林金黄色葡萄球菌(Methicillin Resistant Staphylococcus Aureus,MRSA)的分布及耐药性,为临床经验治疗提供依据。方法回顾性分析2011-2015年门诊及住院患者分离的金黄色葡萄球菌及其临床资料。结果共分离出5 452株金黄色葡萄球菌,其中MSSA 2 554株(46.75%)、MRSA 2 898株(53.15%)。MSSA与MRSA阳性患者平均年龄分别为(29.81±30.68)岁及(52.86±26.85)岁。MSSA和MRSA标本来源前3位均为痰液(55.70%、85.30%)、分泌物(26.45%、5.87%)及脓液(5.46%、2.28%)。MSSA主要来源于门诊(21.15%)和儿呼吸科(12.19%),而MRSA主要来源于神经外科重症监护病房(28.81%)、神经外科(17.49%)及ICU(10.67%)。MSSA和MRSA对万古霉素和利奈唑胺100.00%敏感。MSSA对除青霉素G、氨苄西林和红霉素外的抗菌药物耐药率均20.00%,而MRSA仅对万古霉素、利奈唑胺、呋喃妥因、利福平及复方新诺明敏感,耐药率30.00%。结论临床分离的金黄色葡萄球菌以MRSA为主,MSSA和MRSA在年龄分布、标本来源、科室分布及耐药性方面存在较大差异。MRSA的耐药率明显高于MSSA,临床应根据不同菌株类型的耐药特点选用不同的治疗方案。     

苯唑西林敏感mecA基因阳性金黄色葡萄球菌的鉴定与分析

目的 分析临床分离金黄色葡萄球菌(Staphylococcus aureus,S.aureus)中苯唑西林敏感mecA基因阳性的金黄色葡萄球菌(OS-MRSA)的发生率和生物学特性,为临床预防和治疗S.aureus感染提供理论依据。方法 临床分离的872株S.aureus经全自动微生物分析仪鉴定及药物敏感性检测,表型分析判定苯唑西林耐药金黄色葡萄球菌(MRSA)菌株和苯唑西林敏感金黄色葡萄球菌(MSSA)菌株;采用聚合酶链式反应(PCR)检测mecA基因和其他金黄色葡萄球菌特异基因,通过对比表型和基因分析结果鉴定出OS-MRSA。结果 872株S.aureus 根据临床表型分析判定610株苯唑西林耐药(MRSA)菌株,262株苯唑西林敏感(MSSA)菌株,筛选鉴定出5株OS-MRSA,共4种基因类型,其中有两株属于同一基因类型。结论 该院两年内临床S.aureus感染中根据表型分析MRSA占70%,MSSA占30%,而OS-MRSA占“MSSA”的2%。     

糖尿病足患者耐甲氧西林金黄色葡萄球菌感染相关因素及基因型

目的探讨感染耐甲氧西林金黄色葡萄球菌(MRSA)糖尿病足(DF)患者的临床特点及致病菌基因型分析。方法回顾性分析2014年2月-2017年1月医院收治的380例DF患者的临床资料,对患者足部溃疡基底分泌物进行细菌分离,对分离病原菌进行培养、鉴定及药敏试验,同时根据感染的葡萄球菌为甲氧西林耐药菌或敏感菌,将感染金黄色葡萄球菌(SA)患者分为MRSA组25例和甲氧西林敏感金黄色葡萄球菌(MSSA)组78例,记录DF患者病原菌分布的临床特点及SA的耐药特点,同时比较MRSA和MSSA患者的一般资料,分析MRSA感染的相关因素,并分析MRSA菌株致病基因白细胞毒素基因(PVL)表达情况。结果 380例DF患者溃疡部位分离出病原菌349株,其中革兰阳性菌202株占57.88%,其中SA 103株,MRSA 25株,MSSA 78株;革兰阴性菌138株占39.54%,真菌9株占2.58%。MRSA菌株与MSSA菌株在青霉素G、苯唑西林、氧氟沙星、左氧氟沙星、阿奇霉素、头孢呋辛、头孢噻肟、利福平、呋喃妥因等耐药率比较,差异有统计学意义(P0.05)。入院前6个月抗菌药使用、溃疡病程、溃疡面积、合并高血压和低蛋白血症是DF患者感染MRSA的相关因素(P0.05)。PCR结果显示,25株MRSA均表达mecA耐药基因,且其中4株MRSA携带致病基因PVL。结论 SA是DF溃疡患者常见感染病原菌,且DF患者中MRSA存在多药耐药现象且均表达mecA耐药基因,少数MRSA携带致病基因PVL,临床上应当合理、调整抗菌药物使用,减少耐药性菌株的产生。     

某医院儿科感染耐甲氧西林金黄色葡萄球菌及femA、mecC、PVL耐药基因特点

目的探讨某三甲医院儿科感染耐药金黄色葡萄球菌检出特点及femA、mecC、PVL耐药基因表达改变。方法选择2018年1月-2020年3月医院门诊及住院儿科临床标本分离出的金黄色葡萄球菌株149株,将其分为耐甲氧西林金黄色葡萄球菌(MRSA)组及甲氧西林敏感金黄色葡萄球菌(MSSA)组,对检出金黄色葡萄球菌标本来源分布及MRSA组、MSSA组耐药性特点进行比较;比较两组患儿的临床资料及预后情况;采用聚合酶链式扩增反应对菌株DNA中femA、mecC、PVL耐药基因进行检测。结果 149株检出金黄色葡萄球菌中痰液标本61株占40.94%,检出率最高;MRSA检出率为35.57%(53/149),MRSA组对克林霉素耐药率高于MSSA组(P0.05),两组对其余抗菌药物耐药率差异无统计学意义;所有检出金黄色葡萄球菌对万古霉素、替拉考宁、利奈唑胺耐药率均为0;MRSA组及MSSA组femA基因检出率均为100.00%,mecC检出率均为0,PVL检出率差异无统计学意义。MRSA组预后不良发生率高于MSSA组,差异具有统计学意义(P0.05)。结论本地区SA携带femA、mecC、PVL耐药基因与国内报道无明显差异,MRSA感染患儿预后相对较差,应保持持续关注,为感染防控提供完善的数据。     

Is methicillin-resistant Staphylococcus aureus more contagious than methicillin-susceptible S. aureus in a surgical intensive care unit?

BACKGROUND AND OBJECTIVE: In the Netherlands, the prevalence of methicillin resistance among Staphylococcus aureus isolates has been kept to less than 1% by using active screening programs and isolation. At the University Medical Center Utrecht (UMCU), an active screening program for methicillin-resistant S. aureus (MRSA) in the surgical intensive care unit (ICU) was implemented in 1986. Between 1992 and 2001, only 6 patients with MRSA were admitted to the surgical ICU. However, 4 of these 6 strains were able to spread to 23 other patients and 15 healthcare workers (HCWs). We were surprised by the epidemic behavior of these strains and wondered whether this was exceptional for S. aureus or whether methicillin-susceptible S. aureus (MSSA) was also spreading in the ICU. DESIGN: A 2-month, prospective, observational study to investigate the incidence and spread of MSSA in the surgical ICU of UMCU and historical data collected during a 10-year period regarding MRSA. SETTING: A 10-bed surgical ICU in a 1,042-bed teaching hospital. RESULTS: Weekly swabs revealed the presence of MSSA in 11 (24%) of 45 patients and 16 (22%) of 72 HCWs. Of all 4,105 patient-HCW contacts, there were only 21 episodes in which both the patient and the HCW were found to carry MSSA. With the use of pulsed-field gel electrophoresis, no identical strains could be identified. CONCLUSION: In our surgical ICU, MRSA seems to spread more easily than MSSA, probably because of selection under antibiotic pressure or a still unknown intrinsic factor within MRSA.     

Rates of carriage of methicillin-resistant and methicillin-susceptible Staphylococcus aureus in an outpatient population.

OBJECTIVES: To assess the prevalence of and the clinical features associated with asymptomatic Staphylococcus aureus colonization in a healthy outpatient population, and to compare the characteristics of colonizing methicillin-resistant S. aureus (MRSA) strains with those of strains causing infection in our community and hospital. SETTING: Outpatient military clinics. METHODS: Specimens were obtained from the nares, pharynx, and axillae of 404 outpatients, and a questionnaire was administered to obtain demographic and risk factor information. MRSA strains were typed by pulsed-field gel electrophoresis (PFGE) and evaluated for antibiotic susceptibility. Antibiograms of study MRSA strains were compared with those of MRSA strains causing clinical illness during the same time period. RESULTS: Methicillin-susceptible S. aureus (MSSA) colonization was present in 153 (38%) of the 404 asymptomatic outpatients, and MRSA colonization was present in 8 (2%). Detection of colonization was highest from the nares. No clinical risk factor was significantly associated with MRSA colonization; however, a tendency was noted for MRSA to be more common in men and in those who were older or who had been recently hospitalized. All colonizing MRSA strains had unique patterns on PFGE. In contrast to strains responsible for hospital infections, most colonizing isolates of MRSA were susceptible to oral antibiotics. CONCLUSIONS: MRSA and MSSA colonization is common in our outpatient population. Colonization is best detected by nares cultures and most carriers of MRSA are without apparent predisposing risk factors for acquisition. Colonizing isolates of MRSA are heterogeneous and, unlike nosocomial isolates, often retain susceptibility to other non-beta-lactam antibiotics.     

Methicillin-resistant Staphylococcus aureus (MRSA) isolated in clinics and hospitals in the Fukuoka city area

Bacteriological and clinical studies were carried out on 280 strains of Staphylococcus aureus isolated in clinics and hospitals in the Fukuoka city area from September 1990 to March 1991. The percentage of methicillin-resistant S. aureus (MRSA) strains studied was 41·4% (116 of 280). Of 116 MRSA strains, 48 (41·3%) produced coagulase VII and 21 (18·1%) produced coagulase II. The mean age of the patients who harboured MRSA, 70·5 ± 16·9 years, was significantly higher than that of patients with methicillin-sensitive S. aureus (MSSA), 44·2 ± 29·3 years (P < 0·001). MRSA was detected more frequently than MSSA in sputum (P < 0 · 01), while MSSA was detected more frequently than MRSA in pus (P < 0 · 01). Ninety (89 · 1%) of 101 strains of MRSA were isolated from inpatients and 98 (71 · 0%) of 130 strains of MSSA were isolated from outpatients. Similar number of MRSA strains were recovered in a variety of hospitals, indicating that there was no relationship between hospital size (number of beds) and the incidence of MRSA. As for drug susceptibility, coagulase VII-producing MRSA strains were more sensitive to clindamycin (P < 0 · 01) and more resistant to mino-cycline (P < 0 · 01) than were other MRSA strains.     

耐甲氧西林金黄色葡萄球菌多位点序列分析

目的 对2000年和2005年耐甲氧西林金黄色葡萄球菌(methicillin-resistant Staphylococcus aureus,MRSA)进行多位点序列分析(multilocus sequencing typing,MLST),初步了解MRSA的分子分型特征.方法 采用基因测序的方法 分别对29株MRSA和2株甲氧西林敏感金黄色葡萄球菌(methicillin-sensitive Staphylococcus aureus,MSSA)的7个等位基因进行序列分析,同时进行网上数据库比对,得到每个菌株相应的等位基因号.结果 2000年选取的12株MRSA均为序列型(sequence type,ST)239,2005年的17株MRSA中10株仍为ST239(58.82%,10/17),同时也出现了新的型别ST5(41.18%,7/17).在选取菌株范围内ST239为主要多位点序列分析型别(75.86%,22/29),其次为ST5(24.14%,7/29).2株MSSA分型结果分别为ST6和ST630.结论 ST239和ST5为本次研究的优势型别,MRSA与MSSA在多位点序列分析上存在极大的差异.     

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。     

Nosocomial methicillin-resistant Staphylococcus aureus bacteremia: is it any worse than nosocomial methicillin-sensitive Staphylococcus aureus bacteremia?

OBJECTIVE: To determine the comparative virulence of methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-sensitive S aureus (MSSA) by consideration of predisposing factors and outcomes in patients infected with these organisms in the healthcare setting. DESIGN: Analysis of an historical cohort of 504 bacteremic patients (316 MSSA and 188 MRSA), examining factors associated with mortality. SETTING: A 916-bed, university-affiliated, tertiary referral hospital. RESULTS: Risk factors for the development of MRSA include male gender, admission due to trauma, immunosuppression, presence of a central vascular line or an indwelling urinary catheter, and a past history of MRSA infection. Overall mortality was 22%. Death due to bacteremia was significantly greater in the MRSA group (risk ratio, 1.68; P<.05), although these patients were not found to be more likely to die due to underlying disease during treatment of bacteremia. In those patients who recovered from bacteremia, no significant differences for the outcome of death could be determined between the MRSA and MSSA groups. CONCLUSIONS: There is a general consensus in the published literature that MRSA bacteremia is more likely to be associated with death, and we confirm this conclusion. However, in contrast to other studies, our MRSA cohort does not appear to be more at risk of death due to underlying disease during treatment for bacteremia. Similarly, the general consensus that MRSA patients have an increased overall mortality was not confirmed in our study. Differences in comorbidities of patients may provide some explanation of these conflicting results, while an alternate explanation is that MRSA strains are more virulent than MSSA in some centers. Perhaps the most plausible explanation is that treatment is provided earlier and in a more aggressive fashion in some centers, leading to an overall lower mortality rate in all staphylococcal bacteremias in these institutions.     

临床分离金黄色葡萄球菌的耐药特点和MRSA分子分型

目的研究耐甲氧西林金黄色葡萄球菌(MRSA)的耐药性及其基因分型。方法收集某院2014年1月—2015年11月检出的非重复金黄色葡萄球菌967株,检测其药敏结果及mecA抗性基因、杀白细胞素(PVL)基因;MRSA菌株经多重PCR进行葡萄球菌盒式染色体mec(SCCmec)分型、多位点序列分型(MLST)、金黄色葡萄球菌蛋白A基因(spa)分型、金黄色葡萄球菌附属因子调节子(agr)分型。结果 967株金黄色葡萄球菌共检出210株MRSA,MRSA检出率为21.72%;痰标本MRSA检出率高于皮肤软组织标本(68.09%vs 11.83%,P0.05);金黄色葡萄球菌中未发现对万古霉素和利奈唑胺耐药菌株,MRSA对庆大霉素、四环素、红霉素、克林霉素、左氧氟沙星、环丙沙星、莫西沙星、呋喃妥因、利福平的敏感率均低于MSSA,差异均有统计学意义(均P0.05);MRSA对复方磺胺甲口恶唑的敏感率高于MSSA,差异有统计学意义(P0.05)。皮肤软组织分离的MRSA对庆大霉素、左氧氟沙星、环丙沙星、莫西沙星、利福平的敏感率为86.90%~95.24%,而痰分离的MRSA仅为1.56%~15.63%。967株金黄色葡萄球菌检测出210株携带mecA基因,10株携带PVL基因,210株MRSA中有8株未分型,占3.81%。MLST主要以ST239(177株)为主;SCCmec分型主要以Ⅲ型(177株)为主;spa分型主要以t 030(177株)为主;agr分型主要以Ⅰ型(196株)为主。结论该院MRSA菌株主要流行克隆ST239-MRSA-SCCmecⅢ-t030,耐药形势严峻,应加强医院内耐药菌株的监测。     

苏州市154株金黄色葡萄球菌耐药监测及脉冲场凝胶电泳分型

目的 分析苏州市2014 - 2017年金黄色葡萄球菌（staphylococcus aureus, SAU）的耐药情况和耐甲氧西林金黄色葡萄球菌（methicillin - resistance staphylococcus aureus,MRSA）的脉冲场凝胶电泳（pulsed - field gel electrophoresis, PFGE）分型特征,为临床合理使用抗生素提供参考,为MRSA感染溯源提供技术支持。方法 主要采用MIC法对常见的19种抗生素进行药敏试验,对检测为MRSA的菌株进行PFGE分析。结果 SAU耐药率达到93.5%,未发现万古霉素、达托霉素、奎奴普汀/达福普丁和利奈唑胺的耐药菌株。MRSA多重耐药率达到96.2%。MRSA对多种抗生素的耐药率明显高于甲氧西林敏感金黄色葡萄球菌,且差异具有统计学意义（P＜0.05）。26株MRSA共有15个PFGE型别,有3株100%同源的菌株来自同一所医院3位不同病人。结论 苏州市SAU除对万古霉素、达托霉素、奎奴普汀/达福普丁和利奈唑胺敏感外,对其他抗生素均发现耐药现象,MRSA多重耐药率较高。因此,应用抗生素治疗时建议进行药敏试验。MRSA的PFGE基因型别呈现分布多样性,存在院内传播的可能性,应加强PFGE在溯源分析中的应用。     

ICU患者分离金黄色葡萄球菌的耐药性及分子流行病学特征

目的了解某院重症监护病房（ICU）金黄色葡萄球菌的耐药特点及分子流行病学特征。方法收集2014年1—12月该院ICU分离的金黄色葡萄球菌,进行细菌鉴定及药物敏感性试验,采用金黄色葡萄球菌A蛋白(spa)分型及多位点序列分型(MLST)方法进行分型。结果160株金黄色葡萄球菌中耐甲氧西林金黄色葡萄球菌（MRSA）120株（占75.00%）。MRSA对红霉素、克林霉素、左氧氟沙星的耐药率均＞80%;MSSA对头孢唑林敏感,对红霉素、克林霉素、左氧氟沙星的耐药率分别为62.50%、35.00%、10.00%。spa分型和MLST结果显示,120株MRSA主要为ST239 t030、ST239 t037、ST5 t2460 3种型别,其中ST239 t030（105株,87.50%）为主要流行菌株,8个ICU均有检出;MSSA存在较多型别,ST59 t437仅在神经内科(8株)和消化科（2株）检出,ST6 t701、ST398 t3625、ST398 t1793和ST121 t2092分别仅在神经内科（7株）、麻醉科（5株）、神经外科（4株）和心外科（4株）检出。结论该院ICU MRSA分离率较高,以ST239 t030克隆株为主,存在医院内流行;不同型别MSSA在各科室内存在流行趋势。