耐甲氧西林金黄色葡萄球菌的流行病学及治疗策略研究进展

金黄色葡萄球菌是临床上常见的致病性较强的细菌,是引起医院感染和社区获得性感染常见的致病菌之一。随着广谱抗生素的广泛使用,耐甲氧西林金黄色葡萄球菌(MRSA)的检出率越来越高。由于该菌对环境有较强的适应力,容易在医院内传播流行,已成为医院常见的革兰阳性菌之一,甚至在一些医院引起了暴发流行,这种来源于医院内的耐甲氧西林金黄色葡萄球菌被称为医院获得性MRSA(HA-MRSA)。另外,近年来在无医院或医疗机构接触史的健康人群中发生MRSA感染的现象有所增多,这种MRSA被称为社区获得性MRSA(CA-MRSA)。MRSA具有耐多药的特性,仅对万古霉素等少数抗生素敏感。但是随着万古霉素的使用增加,最近有关对万古霉素中介或者耐药的MRSA的报道逐渐增多。因此,目前临床对于MRSA的治疗显得尤为棘手,引起了学者及临床工作者的高度重视。     

社区获得性耐甲氧西林金黄色葡萄球菌菌血症1例

正耐甲氧西林金黄色葡萄球菌(methicillin resistant staphylococcus aureus,MRSA)自1961年首次发现以来~([1]),其分离率不断增加,在我国是医院相关性感染最重要的革兰阳性球菌,近些年来世界各地亦有危及生命的社区获得性MRSA感染报道,我国CA-MRSA的相关资料较少。现就河北医科大学第三医院2016年8月收治的1例社区获得性MARS感染患者的临床表现及诊治过程进行报告分析,探讨CA-MRSA的临床特点、MRSA菌株的分子特征。     

社区获得性耐甲氧西林金黄色葡萄球菌感染引起的重症肺炎一例

正近年来,社区获得性耐甲氧西林金黄色葡萄球菌(community-acquired methicillin-resistant Staphylococcus aureus,CA-MRSA)引起的感染急剧增加[1],且由CA-MRSA感染所致的重症社区获得性肺炎报道逐步增多。与医院获得性MRSA(hospital-acquired methicillin-resistant     

耐甲氧西林金黄色葡萄球菌杀白细胞素基因亚型的流行及MLST分子分型

目的 探讨临床分离的耐甲氧西林金黄色葡萄球菌(MRSA)杀白细胞素(pvl)基因亚型的流行及MLST分子分型特征.方法 收集非重复MRSA 287株,按照美国疾病预防控制中心的社区获得性耐甲氧西林金黄色葡萄球菌(CA-MR-SA)定义分为医院获得性耐甲氧西林金黄色葡萄球菌(HA-MRSA)和CA-MRSA两组.采用PC...     

流感后CA-MRSA肺炎6例分子流行病学及临床特征分析

目的分析流感后社区获得性耐甲氧西林金黄色葡萄球菌(CA-MRSA)感染病例的分子流行病学及临床特征。方法回顾性分析2014—2022年6例流感后CA-MRSA肺炎的病例, 分离培养6株CA-MRSA, 进行3种分子流行病学分型(SCCmec分型、MLST分型及spa分型)、检测其毒力因子并进行药物敏感性实验;总结病例临床特征及诊疗过程。结果 6株CA-MRSA中ST59-t437-Ⅳ型为主要分型(2/6);杀白细胞素(PVL)检出5例, 溶血素α(HLAα)及酚溶性调节蛋白α(PSMα)检出6例。6例患者中5例为重症肺炎;治疗上, 4例接受过抗病毒治疗, 5例重症肺炎患者均首选万古霉素抗感染治疗且病情好转出院。结论流感后的CA-MRSA分子分型及携带的毒力因子多样;流感后继发CA-MRSA感染更常见于年轻、既往无基础疾病人群, 可引起重症肺炎。流感后合并重症肺炎患者需要及时送病原学检测明确是否为CA-MRSA感染, 给予抗流感病毒及抗CA-MRSA感染治疗。     

耐甲氧西林金黄色葡萄球菌生物膜及其致病性与防治研究进展

耐甲氧西林金黄色葡萄球菌（methicillin—resistant Staphylococcus aureus,MRSA）感染的流行使其成为医院和社区获得性感染的重要致病菌,MRSA具有传播速度快、流行范围广、多部位感染、多耐药性特点,与乙型肝炎、艾滋病并称当今世界三大感染顽疾。而MRSA生物膜的形成使感染慢性化并普难以控制,为临床防治带来极大困难。本文对MRSA生物膜的形成过程、群体感应系统、致病性及耐药机制、防治策略进行综述。充分认识和理解其发生发展规律、治疗策略及临床重要性具有十分重要的意义。     

甲氧西林耐药金黄色葡萄球菌感染与对策

耐药细菌引起的感染越来越受到临床医生的关注,特别是甲氧西林耐药金黄色葡萄球菌(methicillin-resistant Staphylococcus aureus,MRSA)已经成为医院感染的重要病原菌,而发生在社区的MRSA(community-associated MRSA,CA-MRSA)感染更是病情凶险,有效的治疗药物少.     

由社区获得性甲氧西林耐药性金葡菌引起的坏死性筋膜炎

据Medscape．com10月16日报道，一项研究发现了社区获得性甲氧西林耐药性金葡菌（CA-MRSA）与坏死性筋膜炎（NF，一种罕见的软组织感染）之间的关系，强调了在CA-MRSA流行地区需要强效抗生素来治疗NF。     

利奈唑胺治疗耐甲氧西林金黄色葡萄球菌所致肺部感染1例报告

社区发生的葡萄球菌感染由甲氧西林敏感金黄色葡萄球菌引起,传统的抗菌治疗采用头孢菌素类,但近年出现的社区获得性耐甲氧西林金黄色葡萄球菌(CA-MRSA)感染产生了新的问题,已有多起CA-MRSA感染死亡的报道,应引起临床医师的高度重视和反思.本文报道我院1例耐甲氧西林金黄色葡萄球菌(MRSA)所致肺部感染的诊治经验进行分享,希望得到各位老师指正.     

甲氧西林耐药的金黄色葡萄球菌感染一例并文献复习

目的 通过对1例金黄色葡萄球菌染色体基因盒(SCCmec)Ⅴ型的甲氧西林耐药的金黄色葡萄球菌(MRSA)感染病例的分析,增强对MRSA社区或医院获得性感染的认识.方法 对2008年6月19日北京医院皮肤科收治、呼吸科会诊的1例SCCmec Ⅴ型的MRSA感染病例分离自血及痰标本的3株MRSA菌株进行培养及体外药物敏感试验.应用PCR方法对分离菌株进行甲氧西林耐药性决定因子A(mec A)基因鉴定和杀白细胞素(PVL)基因检测,应用多重PCR方法对其进行SCCmec分型.结果 患者男,73岁,因剥脱性皮炎入院,病程中出现MRSA败血症,继之出现双侧肺炎,最终因感染性休克死亡.药物敏感试验结果显示,该MRSA菌株除对β-内酰胺类抗生素耐药外,对其他抗生素如克林霉素敏感,对莫西沙星、庆大霉素为中介性耐药.分离的3株MRSA均属于SCCmec β型.结论 该患者为医院获得性MRSA感染,但其菌株具有社区获得性MRSA的特点,临床医师应注意鉴别.     

社区相关性耐甲氧西林金黄色葡萄球菌感染的流行现状及微生物学特征

耐甲氧西林金黄色葡萄球菌是院内感染常见病原菌之一,也可导致社区相关性感染。社区相关性耐甲氧西林金黄色葡萄球菌(CA-MRSA)与医院相关性耐甲氧西林金黄色葡萄球菌(HA-MRSA)在很多方面存在差异,其对多数非β-内酰胺类抗菌药敏感,大多携带杀白细胞素,多为葡萄球菌染色体mec基因盒Ⅳ或Ⅴ型。CA-MRSA毒力更强,并...     

耐甲氧西林金黄色葡萄球菌（MRSA）感染机制研究进展

耐甲氧西林金黄色葡萄球菌（MRSA）是一种新型金黄色葡萄球菌,它会造成严重感染性疾病。MRSA对p内酰胺类抗生素耐药性的产生及毒力的加强使得它成为了临床治疗的-大痼疾。一些虽然低效但较少产生耐药的抗生素的出现使得MRSA治疗有了新的选择。同时,研究者正在逐渐阐明MRSA基因突变和病原学特征（耐药性、毒力等）的相关性。这些成果都将为今后MRSA的临床治疗以及新药和疫苗的开发提供宝贵的理论支持与指导。     

Methicillin-resistant Staphylococcus aureus: From the hospital to the community

Infections due to community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) are becoming more prevalent. CA-MRSA infections have unique epidemiologic features and virulence factors. Compared with health care-associated MRSA (HA-MRSA), most CA-MRSA is clonal type USA300 or 400 and has the Staphylococcal cassette chromosome mec type IV, which carries the mecA gene that encodes for resistance to methicillin and other β-lactam antibiotics but generally not for other antibiotics. CA-MRSA often contains various virulence factors that may result in tissue necrosis. CA-MRSA clinical presentation includes mostly skin and soft tissue infections and less frequently pneumonia. In many of the small soft tissue abscesses due to CA-MRSA, primary treatment with surgical drainage may result in improvement without antibiotic therapy. Optimal treatment and prevention of CA-MRSA infections are unclear. However, distinction between CA-MRSA and HA-MRSA may be less relevant in the future, as CA-MRSA strains are now diagnosed in the hospital setting.     

Methicillin-resistant Staphylococcus aureus as a cause of invasive infections in Central Africa: a case report and review of the literature

Introduction

Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) colonization and infection are increasingly being reported worldwide and are associated with severe illness. The vast majority of MRSA infections are skin and soft tissue infections, while invasive disease remains rare. In Western countries, the epidemiology of MRSA is well documented, but from Central Africa, reports on MRSA are very limited.

Methods

Case presentation and review of the literature. The clinical features, epidemiology, and characteristics of MRSA in Central Africa, as well as the treatment options, are discussed. We present a case of severe invasive CA-MRSA infection with pneumonia, pericarditis, and bacteremia in a previously healthy young woman in Gabon. Several virulence factors, like Panton–Valentine leukocidin and type I arginine catabolic mobile element, may play a role in the ability of CA-MRSA to cause severe invasive infections. Based on studies from Gabon and Cameroon (no reports were available from other countries), we find that the prevalence of MRSA is relatively low in this region. Treatment depends primarily on local prevalence and resistance profile of MRSA combined with clinical characteristics.

Conclusion

Severe invasive infection with CA-MRSA is a rare disease presentation in Central Africa, where this pathogen is still relatively uncommon. However, cases of MRSA may be complicated by the human immunodeficiency virus (HIV) and tuberculosis epidemics, and also the limited availability of effective antibiotics.     

烧伤患者创面感染金黄色葡萄球菌分离株耐药性及流行病学分析

目的对河北地区烧伤患者创面分离的120株金黄色葡萄球菌进行mecA和SCCmec检测分析MRSA耐药机制,为临床合理用药提供依据。方法在2009~2013年收治的烧伤患者创面中分离的120株金黄色葡萄球菌,采用头孢西丁纸片法进行MRSA筛选,对mecA基因,SCCmec和spa基因进行PCR扩增以及分型。结果 120株金黄色葡萄球菌中有74株为MRSA,占61.7%。药敏试验显示,MRSA对16种临床常见抗生素耐药率,超过85%的有7种,依次为苯唑西林（98.6%）,青霉素（96.0%）,环丙沙星（94.6%）,阿莫西林和头孢唑林（89.2%）,亚胺培南（87.8%）,庆大霉素（85.1%）,另有1株对万古霉素耐药。结论本组金黄色葡萄球菌MRSA检出率较高,并表现出较高的耐药性。MRSA具有的多重耐药性mecA基因密切关系。     

Is Panton-Valentine leukocidin the major virulence determinant in community-associated methicillin-resistant Staphylococcus aureus disease?

Methicillin-resistant Staphylococcus aureus (MRSA) remains a major problem in hospitals, and it is now spreading in the community. A single toxin, Panton-Valentine leukocidin (PVL), has been linked by epidemiological studies to community-associated MRSA (CA-MRSA) disease. However, the role that PVL plays in the pathogenesis of CA-MRSA has not been tested directly. To that end, we used mouse infection models to compare the virulence of PVL-positive with that of PVL-negative CA-MRSA representing the leading disease-causing strains. Unexpectedly, strains lacking PVL were as virulent in mouse sepsis and abscess models as those containing the leukotoxin. Isogenic PVL-negative (lukS/F-PV knockout) strains of USA300 and USA400 were as lethal as wild-type strains in a sepsis model, and they caused comparable skin disease. Moreover, lysis of human neutrophils and pathogen survival after phagocytosis were similar between wild-type and mutant strains. Although the toxin may be a highly linked epidemiological marker for CA-MRSA strains, we conclude that PVL is not the major virulence determinant of CA-MRSA.     

呼吸机相关性肺炎细菌耐药基因的分子流行病学研究

目的了解呼吸机相关性肺炎细菌耐药性及耐药基因分子流行病学特征,为临床诊疗提供参考。方法对呼吸机相关肺炎（VAP）病原菌构成进行分析,采用纸片扩散法检测主要致病菌耐药情况,采用脉冲场凝胶电泳（PFGE）进行主要病原菌的同源性和分子分型研究。结果572例机械性通气患者中VAP患者247例（占43．18％）;共分离致病菌359株,其中革兰阴性菌为231株（64．35％）,革兰阳性菌52株（14．48％）,真菌76株（21．17％）;所有致病菌中,铜绿假单胞菌是主要致病菌,为102株（占28．41％）。铜绿假单胞菌对头孢唑啉和头孢克洛完全耐药,对利福平、氟氯西林的耐药率为98．04％。铜绿假单胞菌共有19个基因型（A～R）,在各基因型中,A型有37株（36．28％）,B型9株（8．82％）,C型6株（5．89％）,D型6株（5．89％）,E型5株（4．90％）。结论VAP主要致病菌存在优势克隆株流行,需要加强耐药性检测,预防暴发流行。     

医院内气载耐甲氧西林金黄葡萄球菌（MRSA）耐药性及耐药基因分析

目的监测医院中气载耐甲氧西林金黄葡萄球菌（MRsA）对临床常用抗生素的耐药性及相关耐药基因。方法用FA-1型六级筛孔撞击式空气微生物采样器采集5所医院的大厅、ICU及病房等场所的空气,分离金黄葡萄球菌,采用头孢两丁纸片法检测MRSA,应用K-B法测定MRSA药敏情况,应用多重PCR扩增MRSA甲氧西林耐药基因rrlecA,氨基糖苷修饰酶基因aacA-aphD,大环内酯类23srRNA甲基化酶基因ermA、errnC,四环素类核糖体保护蛋白基因tetM、tetK以及金黄葡萄球菌属特异性基因16srDNA。结果共采集空气样品250份,分离气载金黄葡萄球菌219株,其中MRSA88株。所有气载MRSA均对青霉素及头孢曲松耐药,对庆大霉素、红霉素及四环素耐药率〉90％,但均对万古霉及素替考拉宁敏感。所有MRSA菌株iTIeCA基因和16srDNA基因均阳性,vat（A）、vat（B）、vat（C）基因均阴性。96％以上MRSA菌株可同时检出氨基糖苷类、红霉素类和四环素类耐药基因,呈现多重耐药;携带aacA—aphD、erm（A）或（和）erm（C）、tetM或（和）tetK耐药基因的MRSA菌株总检出率分别为96．59％、100％和96．59％。结论5所医院空气中均存在MRSA分布且呈多重耐药性,相关耐药基因检出率高。因此应加强对医院空气中致病菌的监测与消毒,预防和控制医院气源病原微生物感染的发生。     

甘肃武威地区2006～2007年常见葡萄球菌感染及耐药状况分析

目的了解甘肃武威地区常见葡萄球菌感染及耐药状况,以更好地指导临床用药。方法将2006～2007年甘肃省武威市医院采集的320株葡萄球菌采用常规方法分离,用Vitek-32全自动微生物分析仪进行菌种鉴定及药敏试验。结果分离到金黄色葡萄球菌192株,表皮葡萄球菌86株,溶血性葡萄球菌42株。其中耐甲氧西林葡萄球菌213株,包括耐甲氧西林金黄色葡萄球菌118株（36．9％）,耐甲氧西林表皮葡萄球菌60株（18．8％）,耐甲氧西林溶血性葡萄球菌35株（10．9％）。耐甲氧西林金黄色葡萄球菌、表皮葡萄球菌和溶血性葡萄球菌均成多重耐药特征,未发现耐万古霉素、替考拉丁的葡萄球菌。结论耐甲氧西林葡萄球菌检出率呈明显上升趋势,合理使用抗生素,尤其万古霉素的使用,已成为当务之急。     

A type III-like restriction endonuclease functions as a major barrier to horizontal gene transfer in clinical Staphylococcus aureus strains

Staphylococcus aureus is an versatile pathogen that can cause life-threatening infections. Depending on the clinical setting, up to 50% of S. aureus infections are caused by methicillin-resistant strains (MRSA) that in most cases are resistant to many other antibiotics, making treatment difficult. The emergence of community-acquired MRSA drastically changed the picture by increasing the risk of MRSA infections. Horizontal transfer of genes encoding for antibiotic resistance or virulence factors is a major concern of multidrug-resistant S. aureus infections and epidemiology. We identified and characterized a type III-like restriction system present in clinical S. aureus strains that prevents transformation with DNA from other bacterial species. Interestingly, our analysis revealed that some clinical MRSA strains are deficient in this restriction system, and thus are hypersusceptible to the horizontal transfer of DNA from other species, such as Escherichia coli, and could easily acquire a vancomycin-resistance gene from enterococci. Inactivation of this restriction system dramatically increases the transformation efficiency of clinical S. aureus strains, opening the field of molecular genetic manipulation of these strains using DNA of exogenous origin.