ICU耐甲氧西林金黄色葡萄球菌的基因检测与感染控制

Detection of Genes for Methicillin-Resistant Staphylococcus Aureus and Monitoring of Infection on the ICU

目的:研究耐甲氧西林金黄色葡萄球菌(MRSA)SCCmec基因分型情况并对其耐药谱进行分析。方法:收集临床标本522例,应用多重PCR法对MRSA进行SCCmec基因分型,采用全自动微生物鉴定药敏分析仪进行细菌的鉴定及药敏试验,部分药敏试验采用K-B法。结果:522例中分离出146例MRSA,其中10株为SCCmec I型(6.84%),29株为SCCmec II型(19.86%),103株为SCCmecⅢ型(70.55%),未分型4株(2.74%)。MRSA分离株对奎奴普汀/达福普汀、替考拉宁、复方磺胺甲恶唑、万古霉素和利奈唑胺敏感,SCC mecII型与SCC mecIII型对氯霉素的耐药率分别为27.59%和11.65%,对利福平的耐药率分别为13.79%和2.91%,存在明显的差异性(P<0.05),其余均呈高水平耐药。146例MRSA患者中治愈52例,占35.62%;感染相关死亡者12例,占8.22%。结论:ICU耐甲氧西林金黄色葡萄球菌的基因检测以SCC mecIII型为主,且对抗菌药物呈多药耐药。

Objective：To study the genotypes of staphylococcal cassette chromosome mec（SCCmec） and analyze the antimicrobial resistance spectrum of meticillin-resistant Staphylococcus aureus（MRSA）.Methods：522 cases with the clinical specimens were collected and the grnotypes of SCCmec were determined by the multiplex PCR.Bacterial identification and antimicrobial susceptibility testing were performed by full automatic microorganism identification and antimicrobial susceptibility testing system.Part of drug susceptibility tests were performed by Kirby-Bauer method.Results：146 strains of MRSA were collected in the 522 samples,10（6.84%） strains belonged to SCCmec I,29（19.86%） strains belonged to SCCmec II,103（70.55%） trains belonged to SCCmec Ⅲ,4（2.74 %） strains belonged to unclassified.The resistance rates of MRSA to Kuinuputing /dalfopristin,teicoplanin,sulfamethoxazole,vancomycin and linezolid were 0.The resistance rates of SCC mecII and SCC mecIII genotypes of MRSA to chloramphenicol were 27.59% and 11.65%,and the rifampicin were 13.79% and 2.91% with statistically significant differences（P〈0.05）.52（35.62%） got cured and 12（8.22%）died of the infection.Conclusion：SCC mecIII is the major genotype of MRSA which was collected from ICU and presented as the multidrug-resistance to antibiotics.