重症监护室与普通病房金黄色葡萄球菌分子分型及其临床特征分析

Analysis on molecular typing and clinical characteristics of Staphylococcus aureus in ICUs and general wards

目的对重症监护病房与普通病房的金黄色葡萄球菌进行分子流行病学分析,并对其临床特点进行比较。方法收集2015年9月至2016年4月临床分离的金黄色葡萄球菌共96株,分别来自于急救科和神经外科重症监护病房43株和普通病房53株,进行细菌鉴定及抗菌药物的药物敏感性试验,采用金黄色葡萄球菌A蛋白(spa)分型方法对其进行分子分型。结果 96株金黄色葡萄球菌中耐甲氧西林金黄色葡萄球菌(MRSA)检出率为40.6%(39/96),重症监护病房43株为62.8%(27/43),普通病房53株为22.6%(12/53)。重症监护病房菌株对庆大霉素、左氧氟沙星、克林霉素、磷霉素、米诺环素耐药率分别为23.3%、48.8%、46.5%、32.6%、32.5%,普通病房分别为7.5%、24.5%、18.9%、2.1%、0。Spa分型结果显示,重症监护病房主要为t002、t091、t311 3种型别,其中t002(16株,37.2%)为主要流行菌株,主要来自于急救科重症监护病房(12株),普通病房菌株分为26个型别,主要为t189、t377、t571、t034、t091、t127。结论重症监护病房MRSA检出率高于普通病房,对常规抗菌药物耐药率高,t002为主要流行株,普通病房spa分型型别较多,遗传多样性高。

Objective To conduct the molecular epidemiologic analysis of Staphylococcus aureus（S.aureus）in the intensive care units（ICUs）and general wards and to compare their clinical characteristics.Methods Ninety-six clinically isolated strains of S.aureus（43strains from the emergency intensive care unit（EICU）and neurosurgical intensive care unit（NICU）and 53 strains from the general wards）collected from Sepetember 2015 to April 2016 were performed the bacterial identification and antibiotic susceptibility test.The molecular typing was performed by adopting staphylococcal protein A（spa）typing method.Results Among 96 strains of S.aureus,the detection rate of methicillin-resistant S.aureus（MRSA）was 40.6%（39/96）,which among 43 strains in ICU was 62.8%（27/43）and which among 53 strains in the general words was 22.6%（12/53）.The resistance rates of strains from ICUs to gentamicin,levofloxacin,clindamycin,fosfomycin and minocycline were 23.3%,48.8%,46.5%,32.6% and 32.5% respectively,while which from the general wards were 7.5%,24.5%,18.9%,2.1% and 0%respectively.The Spa typing results showed that the main types of ICUs were t002,t091 and t311.The major epidemic strain was t002（n=16,37.2%）and mainly isolated from EICUs（12strains）,26 spa types were identified among the general wards trains,mainly were t189,t377,t571,t034,t091,t127.Conclusion The detection rate of MRSA in ICUs is higher than that in the general wards,these strains have high resistant rate to routine antibacterial drugs.t002 is the major epidemic strain.The general wards have more spa types with higher genetic diversity.