某院血流感染金黄色葡萄球菌临床分布特点、耐药性及基因分型研究

摘要

目的 分析该院血流感染金黄色葡萄球菌的临床分布特点、耐药性及基因分型.方法 通过全自动细菌鉴定仪对该院2010年1月至2017年1月分离出的102株血流感染金黄色葡萄球菌行细菌鉴定及药敏试验,同时经PCR测定耐药基因分型.结果 临床分布特点:年龄分布以70~<80岁最多,占29.41%;其次为50~<60岁,占15.69%.科室分布:重症监护病房(IC U)最多,占29.41%;其次为血液透析室,占21.57%.耐药情况:对青霉素耐药率最高,占94.12%;其次为克林霉素,占66.67%;对万古霉素、替加环素、替考拉宁、利奈唑胺均100.00%敏感;耐甲氧西林金黄色葡萄球菌(M RSA)对青霉素、克林霉素、红霉素、庆大霉素、左氧氟沙星、四环素、利福平、环丙沙星、氨苄西林/舒巴坦的耐药率均显著高于甲氧西林敏感金黄色葡萄球菌(MSSA)(P<0.05).基因分型:erm基因携带率100.00%;MRSA中ermA基因12株,ermA+ermC基因28株;MSSA中ermB基因38株,ermC基因24株;诱导型耐药株中ermC基因占77.27%.结论 金黄色葡萄球菌血流感染患者以老年(特别是高龄)人群比较常见,ICU较常见;MRSA检出率较高,金黄色葡萄球菌中erm基因携带率高,MRSA中以ermA基因常见,MSSA中er-mB基因居多,M RSA大部分对多种抗菌药物耐药,建议选择万古霉素、替加环素等敏感度高的抗菌药物治疗.%Objective To analyze the clinical distribution ,drug resistance and genotyping of bloodstream infection Staphylococ-cus aureus in our hospital .Methods Bacteria identification and drug sensitivity test were performed in 102 strains of Staphylococ-cus aureus isolated by automatic bacteria identification system in our hospital during January 2010 to January 2017 ,and the geno-types were determined by polymerase chain reaction (PCR) .Results Staphylococcus aureus bloodstream infection was the most common in people aged 70- <80 years old (29 .41% ) ,followed by the age of 50- <60 years old (15 .69% ) .The disease was the most common in the intensive care unit (ICU) (29 .41% ) ,followed by hemodialysis room (21 .57% ) .The drug resistance rate to penicillin was the highest (94 .12% ) ,followed by clindamycin (66 .67% ) ,and it was sensitive to vancomycin ,tigecycline ,teicoplanin and linezolid (100 .00% ) .The drug resistance rates of Methicillin-resistant Staphylococcus aureus (MRSA) to penicillin ,clindamy-cin ,erythromycin ,gentamicin ,levofloxacin ,tetracycline ,rifampicin ,ciprofloxacin and ampicillin/sulbactam were significantly higher than those of Methicillin-sensitive Staphylococcus aureus (MSSA) (P<0 .05) .The erm gene carrying rate was 100 .00% .Among MRSA ,there were 12 strains carrying ermA gene and 28 strains carrying ermA+ermC gene .Among MSSA ,there were 38 strains carrying ermB gene and 24 strains carrying ermC gene .The ermC gene accounted for 77 .27% in induced drug-resistant strains .Con-clusion Staphylococcus aureus bloodstream infection is more common in the elderly ,especially in the advanced age ,and it is more common in ICU .The detection rate of MRSA is relatively higher ,and the erm gene carrying rate of Staphylococcus aureus is high . ermA gene is common in MRSA while ermB gene is common in MSSA .MRSA is resistant to several antibiotics .It is recommended to choose vancomycin and tigecycline for antibiotic treatment .