上海市医疗机构工作人员手污染金黄色葡萄球菌的分子生物学特征及耐药性

Molecular biological characteristics and antimicrobial resistance of Staphylococcus aureus contaminated on hands of medical staff in Shanghai City

目的分析上海市医疗机构工作人员手分离金黄色葡萄球菌的分子生物学特征及其耐药性。方法选取2018—2020年上海市16所不同级别医院工作人员为研究对象,对医疗机构重点科室工作人员的手进行采样、分离、鉴定金黄色葡萄球菌,对金黄色葡萄球菌进行药敏试验、脉冲肠凝胶电泳(PFGE)和全基因组测序,利用BioNumerics软件对全基因组测序数据组装,对组装基因组开展多位点序列分型(MLST)、核心基因组多位点序列分型(cgMLST)、毒力基因、耐药基因、耐消毒剂基因分析。结果上海市2018—2020年医疗机构工作人员手金黄色葡萄球菌分离率为2.9%。其中MRSA占13.6%(3/22),MSSA占86.4%(19/22)。3株MRSA分别来源于医生、护士和护工,其中1株来源于医生的MRSA携带qacB基因。MSSA对红霉素、环丙沙星、四环素、左氧氟沙星有不同程度的耐药;PFGE和cgMLST显示金黄色葡萄球菌基因多样性,2株相同来源的ST72型金黄色葡萄球菌的PFGE带型高度相似,且仅有10个差异基因,提示为克隆株。结论医疗机构中工作人员的手可作为金黄色葡萄球菌传播的载体,医疗机构内存在经手作为载体导致的金黄色葡萄球菌的医院传播。

Objective To analyze the molecular biological characteristics and antimicrobial resistance of Staphylococcus aureus(SA)isolated from hands of medical staff in Shanghai City.Methods From 2018 to 2020,medical staff of 16 different levels of hospitals in Shanghai were selected as the research objects,hands of medical staff in key departments of medical institutions were sampled,SA was isolated,identified and performed antimicrobial susceptibility testing,pulsed-field gel electrophoresis(PFGE)and whole genome sequencing,the whole genome data were assembled by BioNumerics software,the assembled genomes were conducted multilocus sequence typing(MLST),core genome multilocus sequence typing(cgMLST),virulence genes,drug resistance genes and disinfec-tant resistance genes analysis.Results The isolation rate of SA from hands of medical staff in Shanghai from 2018 to 2020 was 2.9%.Methicillin-resistant SA(MRSA)accounted for 13.6%(3/22),methicillin-susceptible SA(MSSA)accounted for 86.4%(19/22).Three MRSA strains were from doctors,nurses and carers respectively,and 1 MRSA strain from doctors carried qacB gene.MSSA has different resistance to erythromycin,ciprofloxacin,tetracycline and levofloxacin;PFGE and cgMLST showed the genetic diversity of SA,PFGE bands of 2 strains of ST72 SA from the same source were highly similar,and there were only 10 differential genes,suggesting that they were clonal strains.Conclusion Hands of medical staff in medical institutions can be used as a carrier for the transmission of SA,there is transmission of SA through hands as a carrier in medical institutions.