唐山地区儿童CA-MRSA的分子特征及耐药性研究
发布时间：2018-08-24 08:48
【摘要】：目的探究唐山地区儿童CA-MRSA菌株的临床感染特点、分子分型及耐药性特征。方法收集2013年8月-2016年12月在儿童中分离到的金黄色葡萄球菌菌株,采用BD Phoenix?-100全自动细菌鉴定/药敏系统完成鉴定及药敏分析,头孢西丁纸片扩散法筛选出MRSA,调查病历确定为社区获得性耐甲氧西林金黄色葡萄球菌(CA-MRSA),普通PCR技术和琼脂糖凝胶电泳技术检测mec A基因,以确证是MRSA。并采用多重PCR技术和琼脂糖凝胶电泳技术,进行葡萄球菌染色体mec基因盒(SCCmec)分型。再采用普通PCR技术、琼脂糖凝胶电泳技术以及DNA测序技术相结合,对菌株进行葡萄球菌A蛋白基因(spa)分型和多位点序列分型(MLST)以及杀白细胞毒素基因(pvl)携带情况进行研究。结果1病例符合标准的菌株共检出102株CA-MRSA,标本类型以痰液和脓性分泌物为主,在102例感染CA-MRSA的患儿中,男64例(62.7%),女38例(37.3%),年龄为0-14岁,其中0-28天24例(23.5%),28天-6月45例(44.1%),6月-1岁15例(14.7%),1岁-3岁14例(13.7%),3岁-14岁4例(3.9%)。2在CAMRSA患儿中,最常见的感染为肺炎55例,其次为皮肤软组织感染37例,血流感染8例。3 102例菌株对于利奈唑胺、替考拉宁、万古霉素全部为100%敏感,对于β-内酰胺类抗生素100%耐药,然而对于红霉素、克林霉素、甲氧苄胺嘧啶、四环素、妥布霉素的耐药率较高,分别为93.1%、89.2%、44.1%、26.5%、13.7%,其他的抗生素具有不同的耐药表现。4 SCCmec基因分型共有五种类型,其中SCCmec IV占56.9%(58/102),SCCmec V占18.6%(19/102),SCCmec III占11.8%(12/102),SCCmec II占3.9%(4/102),SCCmec I占1.0%(1/102)。pvl阳性携带率为29.4%(30/102)。spa分型17种,以t437为主,占48.0%,其他型别还有t324、t441、t021、t309、t318、t668、t968、t1751、t3523、t3527、t3424、t2592、t127、t037、t030、t311,未分型菌株有3株。MLST分型14种,以ST59为主,占48.0%(49/102),其次是ST910(10)和ST88(13),存在的其他型别还有ST5、ST398、ST30、ST1777、ST82、ST45、ST338、ST1、ST72、ST239和ST22。5在102株CA-MRSA菌株中,其流行的分子克隆是以MRSA-ST59-SCCmec IVa-t437为主,共30株,所占比例为29.4%,其次的分子克隆为MRSA-ST59-SCCmec Vt437,共10株,所占比例为9.8%。流行分子克隆MRSA-ST59-SCCmec IVa-t437菌株,对于β-内酰胺类抗生素100%耐药,对利奈唑胺、替考拉宁、万古霉素100%敏感,对于红霉素、克林霉素、甲氧苄胺嘧啶和四环素的耐药率较高,分别为90.0%、83.3%、63.3%和36.7%,其他的抗生素具有不同的耐药表现。结论1儿童CA-MRSA引起的感染主要是肺炎和皮肤软组织感染,感染的患儿以婴幼儿为主。2儿童CA-MRSA感染的经验性治疗慎用克林霉素和红霉素,可以应用利奈唑胺、替考拉宁、万古霉素,最好个性化治疗。3儿童CA-MRSA感染的流行分子克隆以MRSA-ST59-SCCmec IVa-t437为主,与中国大陆其他地区相同。4流行分子克隆MRSA-ST59-SCCmec IVa-t437菌株,对于β-内酰胺类抗生素耐药,对利奈唑胺、替考拉宁、万古霉素敏感,对于红霉素、克林霉素、甲氧苄胺嘧啶和四环素的耐药率较高。
[Abstract]:Objective to investigate the clinical infection characteristics, molecular typing and drug resistance of CA-MRSA strains in children in Tangshan area. Methods Staphylococcus aureus strains isolated from children from August 2013 to December 2016 were collected and identified by BD Phoenix?-100 automatic bacterial identification / drug sensitivity system. Cefxitin disk diffusion method was used to screen out the history of MRSA, investigation confirmed as community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA), common PCR and agarose gel electrophoresis were used to detect mec A gene, which was confirmed as MRSA.. Multiplex PCR and agarose gel electrophoresis were used for (SCCmec) typing of staphylococcus chromosome mec cassette. The common PCR technique, agarose gel electrophoresis and DNA sequencing techniques were used to study the carrying of staphylococcal A protein gene (spa) typing, multilocus sequence typing (MLST) and leukocytotoxin gene (pvl). Results (1) sputum and purulent secretions were the main types of CA-MRSA, samples from 102 patients who met the criteria. 64 (62.7%) males and 38 (37.3%) females were infected with CA-MRSA, aged 0-14 years. There were 24 cases (23.5%) with 0-28 days and 45 cases (44.1%) from 28 days to June, 15 cases (14.7%) from June to June, 14 cases (13.7%) from 1 year old to 3 years old, 4 cases (3.9%) from 3 to 14 years old. Among the children with CAMRSA, the most common infection was pneumonia in 55 cases, followed by skin and soft tissue infection in 37 cases. Blood flow infection 8 cases 3.102 strains were 100% sensitive to linazolamine, teicoplanin and vancomycin, and 100% resistant to 尾 -lactam antibiotics. However, they were resistant to erythromycin, clindamycin, methoxybenzylamine, tetracycline, erythromycin, clindamycin, methoxybenzylamine, tetracycline. 濡ュ竷闇夌礌鐨勮，
本文编号：2200261
[Abstract]:Objective to investigate the clinical infection characteristics, molecular typing and drug resistance of CA-MRSA strains in children in Tangshan area. Methods Staphylococcus aureus strains isolated from children from August 2013 to December 2016 were collected and identified by BD Phoenix?-100 automatic bacterial identification / drug sensitivity system. Cefxitin disk diffusion method was used to screen out the history of MRSA, investigation confirmed as community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA), common PCR and agarose gel electrophoresis were used to detect mec A gene, which was confirmed as MRSA.. Multiplex PCR and agarose gel electrophoresis were used for (SCCmec) typing of staphylococcus chromosome mec cassette. The common PCR technique, agarose gel electrophoresis and DNA sequencing techniques were used to study the carrying of staphylococcal A protein gene (spa) typing, multilocus sequence typing (MLST) and leukocytotoxin gene (pvl). Results (1) sputum and purulent secretions were the main types of CA-MRSA, samples from 102 patients who met the criteria. 64 (62.7%) males and 38 (37.3%) females were infected with CA-MRSA, aged 0-14 years. There were 24 cases (23.5%) with 0-28 days and 45 cases (44.1%) from 28 days to June, 15 cases (14.7%) from June to June, 14 cases (13.7%) from 1 year old to 3 years old, 4 cases (3.9%) from 3 to 14 years old. Among the children with CAMRSA, the most common infection was pneumonia in 55 cases, followed by skin and soft tissue infection in 37 cases. Blood flow infection 8 cases 3.102 strains were 100% sensitive to linazolamine, teicoplanin and vancomycin, and 100% resistant to 尾 -lactam antibiotics. However, they were resistant to erythromycin, clindamycin, methoxybenzylamine, tetracycline, erythromycin, clindamycin, methoxybenzylamine, tetracycline. 濡ュ竷闇夌礌鐨勮，
本文编号：2200261
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