血流感染金黄色葡萄球菌耐药性变化及其流行趋势

Antibiotic resistance and epidemiology of Staphylococcus aureus causing bloodstream infections

目的收集上海交通大学医学院附属新华医院2011-2019十年间分离自血培养标本中的金黄色葡萄球菌,进行耐药性分析及流行病学分析。方法利用Whonet 5.6软件对十年间分离自血培养的金黄色葡萄球菌进行耐药分析,计算成人和儿童的甲氧西林耐药金黄色葡萄球菌(MRSA)检出率。对十年间收集的部分菌株进行DNA提取,并进行多位点序列分型(MLST)分析,了解金黄色葡萄球菌在医院的流行趋势。结果十年间分离自血培养标本的金黄色葡萄球菌共320株,分离自儿童的菌株占35.0%,分离自成人的菌株占65.0%,MRSA的总检出率为47.5%,儿童MRSA的检出率为45.5%,成人MRSA的检出率为48.5%。对其中250株金黄色葡萄球菌进行MLST分型,MRSA的主要型别是ST5(35.4%),甲氧西林敏感金黄色葡萄球菌(MSSA)的主要型别是ST188(16.7%),分离自儿童的菌株主要型别是ST59(17.9%),分离自成人的菌株主要型别是ST5(26.2%)。结论分离自成人和儿童的金黄色葡萄球菌耐药性存在差异,成人MRSA检出率略高于儿童,流行的ST型也存在明显差异,提示临床医生应该针对不同的人群进行经验性抗感染治疗和医院感染控制。

OBJECTIVE To isolate Staphylococcus aureus strains from blood samples of patients in Xinhua Hospital affiliated to Shanghai Jiaotong University School of Medicine during 2011 to 2019.Antibiotic resistance and epidemiology of the strains were analyzed.METHODS The antibiotic resistance of S.aureus isolated from blood culture during 10 years were analyzed by Whonet 5.6 software,and the detection rate of MRSA in adults and children were calculated.Some strains collected in the past 10 years were selected for DNA extraction and MLST analysis to understand the epidemic trend of S.aureus in our hospital.RESULTS A total of 320 strains of S.aureus were isolated from blood culture specimens in the past ten years,of which 35.0%were isolated from children and 65.0%were from adults.The overall detection rate of MRSA was 47.5%,and the detection rate of children isolates was 45.5%,the detection rate of adult isolates was 48.5%.Among them,250 strains of S.aureus were selected for MLST typing.The main type of MRSA was ST5(35.4%),The main type of MSSA strains was ST188(16.7%),ST59(17.9%)was the children isolates and ST5(26.2%)was the adults isolates.CONCLUSION There are differences in antibiotic resistance of S.aureus between strains isolated from adults and children.The detection rate of MRSA in adults is slightly higher than that in children.The main ST type is also significantly different,suggesting empirical anti-infective therapy and nosocomial infection control for different populations should be performed.