社区获得性耐甲氧西林金黄色葡萄球菌SCCmec基因分型及药敏结果

SCCmec genotyping and antimicrobial susceptibility of community-acquired methicillin-resistant Staphylococcus aureus

目的了解某院门诊和住院患者标本分离的社区获得性耐甲氧西林金黄色葡萄球菌(CA-MRSA)盒式染色体基因(SCCmec)型别以及CA-MRSA耐药性。方法收集该院2011年5月—2015年8月分离的MRSA及其相关病史资料,利用聚合酶链反应(PCR)方法进行MRSA的mecA基因和CA-MRSA的SCCmec基因分型检测,对CA-MRSA进行药物敏感性试验并进行统计分析。结果共收集MRSA 305株,其中mecA阳性296株。CA-MRSA88株,占29.73%(88/296),其中48株为SCCmecⅣ型,36株为SCCmecⅤ型,4株未定型。药敏试验显示,CA-MRSA对万古霉素、利奈唑胺、替加环素均100%敏感,对青霉素和苯唑西林100%耐药;SCCmecⅣ和Ⅴ型CA-MRSA对左氧氟沙星、利福平、环丙沙星的耐药率比较,差异均有统计学意义(均P<0.05)。SCCmecⅣ、Ⅴ型CA-MRSA对氨苄西林/舒巴坦、呋喃妥因、红霉素的耐药率均>58%。结论该院CA-MRSA的SCCmec分型以Ⅳ和Ⅴ型为主,且耐药率较高,临床医生应对此高度重视,根据药敏结果合理应用抗菌药物。

Objective To investigate the types of staphylococcal cassette chromosome mec （SCCmec）gene and an-timicrobial resistance of community-acquired methicillin-resistant Staphylococcus aureus （CA-MRSA）isolated from outpatients and inpatients in a hospital.Methods MRSA strains isolated between May 2011 and August 2015 in a hospi-tal and the relevant case data were collected,polymerase chain reaction（PCR）method was used to identify mecA gene of MRSA and SCCmec gene of CA-MRSA,antimicrobial susceptibility testing of CA-MRSA were performed and analyzed. Results A total of 305 MRSA isolates were collected,296 of which were mecA positive,29.73% （88/296）were CA-MR-SA. The genotyping of CA-MRSA showed that 48 strains were SCCmec type Ⅳ,36 were SCCmec type V,the other 4 strains were undefined. Antimicrobial susceptibility testing results showed that susceptibility rates of CA-MRSA to vanco-mycin,linezolid,and tigecycline were all 100% ,resistance rates to penicillin and oxacillin were both 100% ;resistance rates of SCCmec type IV and SCCmec type V CA-MRSA strains to levofloxacin,rifampicin,and ciprofloxacin were all signifi-cantly different （all P〈0.05）,to ampicillin/sulbactam,furantoin,and erythromycin were all 〉58% .Conclusion The main SCCmec type of CA-MRSA are type IV and type V in this hospital,antimicrobial resistance rate is high,clinicians should pay high attention,and use antimicrobial agents according to antimicrobial susceptibility testing results.