摘要
目的:了解贵州省从江县人民医院重症医学科下呼吸道感染患者金黄色葡萄球菌耐药变迁情况,掌握耐甲氧西林金黄色葡萄球菌的主要耐药基因和耐消毒剂基因,并对部分菌株作同源性分析。方法:回顾性分析贵州省从江县人民医院重症医学科下呼吸道感染患者2018~2021年金黄色葡萄球菌耐药情况变迁情况,以相关性分析(pearson)统计学方法探讨细菌耐药性与抗菌药物用药频度(defined daily dose system,DDDs)二者的关系。以四年间重症医学科下呼吸道感染患者送检标本分离获得的40株耐甲氧西林金黄色葡萄球菌为研究对象,采用仪器法对试验菌株作鉴定及药敏,通过PCR技术作耐药基因(mecA、SCCmec、femB)和耐消毒剂基因(qacA/B)检测。应用多位点序列分型(MLST)法分析40株试验菌的同源性。结果:金黄色葡萄球菌每年的平均耐药率显示青霉素耐药率一直高于92%以上。四环素、克林霉素、复方新诺明耐药率在2019年有所下降后却又再次持续升高。红霉素、苯唑西林、左氧氟沙星、奎奴普丁/达福普丁的耐药率呈现逐年增长趋势。未发现对利奈唑胺、万古霉素和替加环素的耐药菌株。相关性分析提示青霉素耐药率与苯唑西林DDDs存在明显正相关(r=0.99,P<0.05),苯唑西林耐药率与红霉素DDDs存在明显负相关等,其他抗菌药物耐药率与各药物DDDs相关性无统计学意义。基因检测发现40株耐MRSA中mecA检出率为97.5%,SCCmec和femB基因未检出,qacA/B基因检出率为15%。MLST分型结果显示共分为7个序列型,其中以ST59型占比最高,为优势型别,占比42.5%,其次为ST45型,占25%,ST239型、ST28型、ST188型、ST1型和ST630型分别占12.5%、7.5%和5%、5%、2.5%。结论:重症医学科下呼吸道感染金黄色葡萄球菌耐药率逐年增加,可选择的抗生素有限。细菌耐药性的产生与药物使用频率有一定关系,携带mecA和qacA/B基因是耐甲氧西林金黄色葡萄球菌产生耐药的主要原因。MLST结果表明ICU病房存在科内克隆菌株。
Objective:To understand the changes in drug resistance of Staphylococcus aureus in patients with lower respiratory tract infections in the Department of Critical Care Medicine,Congjiang County People′s Hospital,Guizhou Province,to understand the main drug-resistant genes and disinfectant-resistant genes of methicillin-resistant Staphylococcus aureus,and to analyze some strains Perform homology analysis.Methods:This study retrospectively analyzed the changes in Staphylococcus aureus drug resistance in patients with lower respiratory tract infections in the Department of Critical Care Medicine,Congjiang County People′s Hospital,Guizhou Province from 2018 to 2021,and used correlation analysis(pearson)statistical methods to explore the relationship between bacterial resistance and antibacterial drugs medication frequency(defined daily dose system,DDDs).Totally 40 strains of methicillin-resistant Staphylococcus aureus were isolated from specimens submitted by patients with lower respiratory tract infections in the Department of Critical Care Medicine over the past four years were used as the research objects.Instrumental methods were used to identify the test strains and their drug susceptibility,and PCR technology was used to determine the resistance genes(mecA,SCCmec,femB)and disinfectant resistance genes(qacA/B)detection.Multilocus sequence typing(MLST)method was used to analyze the homology of 40 strains of test bacteria.Results:The annual average resistance rate of Staphylococcus aureus shows that the penicillin resistance rate has always been higher than 92%.The resistance rates to tetracycline,clindamycin,and cotrimoxazole continued to increase again after declining in 2019.The resistance rates of erythromycin,oxacillin,levofloxacin,and quinupristin/dalfopristin shows an increasing trend year by year.No strains resistant to linezolid,vancomycin,and tigecycline were found.Correlation analysis shows that there is a significant positive correlation between the penicillin resistance rate and oxacillin DDDs(r=0.99,P<0.05),there is a significant negative correlation between the oxacillin resistance rate and erythromycin DDDs,etc.,and the resistance rates of other antibacterial drugs.There is no statistical significance in the correlation with DDDs of each drug.Genetic testing found that the detection rate of mecA in 40 strains of resistant MRSA was 97.5%,the SCCmec and femB genes were not detected,and the detection rate of qacA/B genes was 15%.The MLST typing results show that there are 7 sequence types in total,among which ST59 type has the highest proportion and is the dominant type,accounting for 42.5%,followed by ST45 type,accounting for 25%,ST239 type,ST28 type,ST188 type,ST1 type and ST630 account for 12.5%,7.5% and 5%,5% and 2.5% respectively.Conclusion:The drug resistance rate of Staphylococcus aureus in lower respiratory tract infections in the Department of Critical Care Medicine is increasing year by year,and the antibiotics available are limited.The development of bacterial resistance is related to the frequency of drug use.Carrying the mecA and qacA/B genes is the main reason for the development of drug resistance in methicillin-resistant Staphylococcus aureus.MLST results indicate the presence of intrafamily clonal strains in the ICU ward.
作者
张立荣
江滟
ZHANG Lirong;JIANG Yan(Micro Exemption Teaching and Research Office of the School of Laboratory Medicine,Guizhou Medical University,Guiyang 550025,China;Laboratory Department of People's Hospital of Congjiang County,Qiandongnan Prefecture,Congjiang 557400,China;Clinical Laboratory Center of Guizhou Medical University Affiliated Hospital Micro Immunology Department,Guiyang 550004,China)
出处
《海南医学院学报》
CAS
北大核心
2024年第8期582-590,共9页
Journal of Hainan Medical University
基金
贵州省科技计划项目[黔科合平台人才(2019)5610号]
贵州省教育厅创新群体项目[黔教合KY字(2021)016]。
关键词
金黄色葡萄球菌
敏感性
耐药性
耐药基因
同源性
Staphylococcus aureus
Sensitivity
Drug resistance
Drug resistance gene
Homology
