耐甲氧西林金黄色葡萄球菌的耐药性分析与毒力基因检测的研究

发布时间：2018-04-05 12:16

本文选题：耐甲氧西林金黄色葡萄球菌　切入点：药敏试验　出处：《宁夏医科大学》2017年硕士论文

【摘要】：目的了解金黄色葡萄球菌(SAU)的临床分布、标本来源、抗菌药物耐药情况,并对耐甲氧西林金黄色葡萄球菌(MRSA)菌株和甲氧西林敏感金黄色葡萄球菌(MSSA)菌株的毒力基因进行检测,能够为预防医院感染的发生、控制病原菌感染的扩散、监测医院感染情况及临床合理使用抗菌药物提供科学的指导。方法收集医院2015年7月-2016年7月从临床标本中的金黄色葡萄球菌303株,将传统手工方法与质谱相结合鉴定至种。SAU的药物敏感性试验采用纸片扩散法(K-B法)进行,并使用WHONET 5.6软件对抗菌药物的耐药结果进行分析。使用聚合酶链式反应(PCR)法检测51株MRSA和52株MSSA中mec A基因及肠毒素A(sea)、肠毒素B(seb)、杀白细胞素(pvl)、α-溶血素(hla)、纤维蛋白结合蛋白A(fnb A)毒力基因的分布情况,并使用SPSS 17.0软件对MRSA与MSSA中毒力基因的检出率进行比较分析。结果303株SAU中MRSA为125株而MSSA为178株,两者分别占41.3%和58.7%;SAU主要来自烧伤科、耳鼻喉科、神经外科,其构成比分别为15.2%、11.6%、10.6%;SAU主要来源于伤口分泌物和痰液,其构成比分别为31.0%和30.7%。MRSA对青霉素G、头孢呋辛、头孢西丁、头孢噻肟、头孢唑林的耐药率均为100%;MRSA和MSSA中未发现对万古霉素、替考拉宁和利奈唑胺耐药的菌株。MRSA对阿米卡星、红霉素、克林霉素、利福平、庆大霉素、四环素、环丙沙星、左氧氟沙星的耐药率较高(48.0%);MSSA对红霉素的耐药率较高,其耐药率为68.0%。51株MRSA和52株MSSA进行mec A基因检测,MRSA中mec A基因的携带率为100%,而MSSA中mec A基因的携带率为0;对两者进行毒力基因sea、seb、hla、fnb A、pvl的检测,MRSA菌株和MSSA菌株中这些基因携带率分别为74.5%(38/51)、68.6%(35/51)、94.1%(48/51)、80.4%(41/51)、7.8%(4/51)和61.5%(32/52)、59.6%(31/52)、88.5%(46/52)、96.2%(50/51)、28.8%(15/52)。结论MRSA对β-内酰胺类抗菌药物的耐药率非常高,并对大环内酯类、氨基糖苷类、氟喹诺酮类、林可霉素类、四环素类、复方新诺明等抗菌药物有不同程度耐药特性,MRSA对多种抗菌药物的耐药率普遍高于MSSA;MRSA和MSSA中未发现对万古霉素、替考拉宁和利奈唑胺耐药的菌株。mec A基因只存在于MRSA中;毒力基因sea、seb、hla、fnb A、pvl在MRSA和MSSA中的携带率各不相同,毒力基因sea、seb和hla在两者中的检出率差异没有统计学意义(P0.05),但毒力基因fnb A和pvl的检出率差异具有统计学意义(P0.05)。
[Abstract]:It can provide scientific guidance for the prevention of nosocomial infection, the control of the spread of pathogenic bacteria, the monitoring of nosocomial infection and the rational use of antimicrobial agents in clinic.Methods 303 strains of Staphylococcus aureus were collected from clinical samples from July 2015 to July 2016 in our hospital. The drug sensitivity test of traditional manual method combined with mass spectrometry was carried out by disk diffusion method and K-B method.The results of antimicrobial resistance were analyzed by WHONET 5. 6 software.Polymerase chain reaction (PCR) was used to detect the distribution of the virulence genes of mec A gene and enterotoxin Astragalus, enterotoxin Bransebr, leukocytoin, 伪 -hemolysin hlaa and fibrin binding protein A(fnb A in 51 MRSA and 52 MSSA strains.SPSS 17.0 software was used to compare the detection rate of MRSA and MSSA poisoning genes.Results among the 303 strains of SAU, 125 were MRSA and 178 were MSSA, which accounted for 41.3% and 58.7%, respectively, and mainly came from Burns, Otorhinolaryngology and Neurosurgery. The constituent ratio of MRSA and MSSA were 15.211.6% and 10.6%, respectively, which were mainly derived from wound secretions and sputum.The resistance rates of 30.7%.MRSA to penicillin G, cefuroxime, cefotaxime, cefotaxime and cefazolin were 31.0% and 31.0%, respectively.Erythromycin, clindamycin, rifampicin, gentamicin, tetracycline, ciprofloxacin, levofloxacin have higher resistance to erythromycin.The rate of drug resistance was 68.0.51 strains of MRSA and 52 strains of MSSA were tested for mec A gene. The carrying rate of mec A gene in MRSA was 100, while that of mec A gene in MSSA was 0. The virulence gene of mec A gene was detected by the virulence gene sea sebbhlahlahlafnb Apvl in MRSA strains and MSSA strains.Conclusion the resistance of MRSA to 尾 -lactam antibiotics is very high, and to macrolides, aminoglycosides, fluoroquinolones, lincomycin and tetracycline.The resistance rate of MRSA to multiple antimicrobial agents was higher than that of MSSA-MRSA and MSSA. The resistance of teicoplanin and linazolamide was only found in MRSA.
【学位授予单位】：宁夏医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R446.5

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