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上海市卫生健康委员会
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57株HA-MRSA的SCCmec基因分型及耐药性分析
Genotyping of Staphylococcal Cassette Chromosome mec and Antimicrobial Resistance of 57 HA- Methicilin-Resistant Staphylococcus Aureus

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DOI:
作者:
栾一鸣，颜泽敏，黄海，唐昊
LUAN Yiming，YAN Zemin，HUANG Hai，TANG Hao
作者单位:
上海长征医院
Department of Respiratory Medicine, Changzheng Hospital, Second Military Medical University, Shanghai
关键词:
耐甲氧西林金黄色葡萄球菌；葡萄球菌染色体mec盒；聚合酶链反应；抗药性
methicillin-resistant Staphylococcus aureus(MRSA) staphylococcal cassette chromosome mec(SCCmec) polymerase chain reaction drug resistance
摘要:
目的：了解我院临床分离医院获得性耐甲氧西林金黄色葡萄球菌（HA-MRSA）染色体mec盒(SCCmec）的分型及耐药状况。方法：收集我院2010年8月-2011年8月从医院获得性肺炎下呼吸道分离的57株MRSA。应用聚合酶链式反应（PCR）技术检测mecA基因，多重PCR方法对MRSA进行SCCmec基因分型(Ⅰ、Ⅱ、Ⅲ、Ⅳa，b，c，d、Ⅴ)。采用标准的K-B纸片琼脂扩散法测定MRSA对13种抗生素的敏感性，包括青霉素、苯唑西林、头孢西丁、环丙沙星、左氧氟沙星、克林霉素、头孢曲松、红霉素、利福平、万古霉素、替考拉林、利奈唑胺和复方磺胺甲恶唑（TMP-SMZ）。结果：SCCmec分型结果显示57株MRSA的mecA均为阳性，SCCmecⅡ型11株(19.3%)；SCCmecⅢ型19株(33.3%)；SCCmecⅣb型1株，SCCmecⅣc型1株，SCCmecⅣd型7株，另有18株mecA基因阳性菌株未能分型(31.6%)。所有SCCmecⅡ型、Ⅲ型菌株对β-内酰胺类抗生素完全耐药，对其他非β-内酰胺类抗生素呈多重耐药。9例SCCmecⅣ型MRSA中，仅有1例Ⅳb型对非β-内酰胺类抗生素敏感，其余8例均为多重耐药。57株MRSA临床株对万古霉素、替考拉宁、利奈唑胺仍保持100％敏感，82.5%以上的MRSA菌株对利福平保持敏感，56.1%的菌株对TMP-SMZ也保持敏感。结论：我院临床分离HA-MRSA的SCCmec 基因型以Ⅲ型、Ⅱ型为主，除一株携带SCCmecⅣb型的MRSA外，其余56株(包括SCCmecⅡ、Ⅲ、Ⅳc、Ⅳd)均具有多重耐药的特征。
Objective: Methicillin-resistant Staphylococcus aureus (MRSA) has become one of the most commonly identified antibiotic-resistant pathogens in many parts of the world. Our present study investigated genotype characteristics of staphylococcal cassette chromosome mec (SCCmec) and antimicrobial resistance of MRSA isolated from Shanghai Changzheng Hospital. Methods: A total of 57 bacterial isolates of MRSA were isolated from various clinical specimens of inpatients from August 2010 to August 2011.The polymerase chain reaction (PCR) was used to detect mecA gene. Multiplex PCR was used to detect the SCCmec genotype(Ⅰ、Ⅱ、Ⅲ、Ⅳa，b，c，d、Ⅴ). Antimicrobial susceptibility of 13 antibiotics (penicillin, oxacillin, cefoxitin, ciprofloxacin, levofloxacin, clindamycin, ceftriaxone, erythromycin, rifampicin, vancomycin, teicoplanin, linezolid and trimethoprin-sulfamethoxazole) was determined by agar diffusion method. Results: All of the 57 strains were positive for mecA gene. SCCmecⅡwas identified in 11(19.3%) isolates, SCCmecⅢ in 19(33.3%) isolates, SCCmecⅣb in 1, SCCmecⅣc in 1 and SCCmecⅣd in 7 isolates.18 MRSA strains were nontypable. The SCCmecⅡ, SCCmecⅢ and mostly SCCmecⅣ isolates were multi-resistant to antibiotics except for the only one SCCmecⅣb strain, which was susceptible to all antibiotics except β-lactams. All of the testing strains were susceptible to vacomycin, teicoplanin, linezolid, and had relatively low resistant rate to rifampicin and sulfamethoxazole-trimethoprim (17.50% and 43.9%, respectively). Conclusion: SCCmecⅢ and SCCmecⅡ are the main genotypes of HA-MRSA from Shanghai Changzheng hospital. All of the strains (SCCmecⅡ, Ⅲ, Ⅳc, Ⅳd) are multi-resistant to tested antibiotics except one isolate with SCCmecⅣb.

 

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