沈阳地区金黄色葡萄球菌感染患者万古霉素治疗无效的研究

发布时间：2018-03-11 20:45

本文选题：金黄色葡萄球菌　切入点：耐甲氧西林金黄色葡萄球菌　出处：《中华医院感染学杂志》2015年04期 　论文类型：期刊论文

【摘要】：目的探讨沈阳地区部分医院万古霉素治疗金黄色葡萄球菌感染患者失败的因素,为有效治疗提供依据。方法 2011年6月-2012年8月对临床分离的172株金黄色葡萄球菌中耐甲氧西林金黄色葡萄球菌(MRSA)102株、甲氧西林敏感金黄色葡萄球菌(MSSA)70株,采用E-test法检测其对万古霉素最低抑菌浓度MIC值;用含万古霉素4.0μg/ml的脑心浸液琼脂培养基筛选异质性万古霉素中介耐甲氧西林金黄色葡萄球菌(hVISA),在无万古霉素血平皿培养基中对MRSA进行连续传代培养,检测其对万古霉素MIC值的变化。结果 172株临床分离金黄色葡萄球菌,对万古霉素MIC值在(1.0~2.0)μg/ml有146株,占84.89%;102株MRSA对万古霉素MIC值在(1.0~2.0)μg/ml有88株,占86.27%,其中有两株MIC值为(2.5~3.0)μg/ml;70株MSSA对万古霉素MIC值在(1.0~1.5)μg/ml有46株,占65.71%,其余1.0μg/ml;含万古霉素4.0μg/ml的脑心浸液琼脂培养基未筛选出hVISA,也未筛选出对万古霉素MIC值8.0μg/ml的VRSA;体外传代培养发现,MRSA对万古霉素的MIC值随传代次数呈现一定变化规律。结论沈阳地区hVISA检出率极低,大部分临床治疗失败可能与菌株MIC值漂移有关,MIC值漂移菌株脱离抗菌药物环境连续传代,其MIC值较初始分离时未见下降,提示MIC值的漂移可能也涉及到了稳定的遗传变异,其机制有待进一步研究。
[Abstract]:Objective to investigate the infection factors of the patients with failure of vancomycin in the treatment of Staphylococcus aureus in some hospitals in Shenyang area, to provide a basis for effective treatment. Methicillin resistant Staphylococcus aureus methods in June 2011 -2012 year in August 172 clinical isolates of Staphylococcus aureus (MRSA) and 102 strains of methicillin sensitive Staphylococcus aureus (MSSA 70) strains, to detect the vancomycin mic value using MIC E-test method; medium screening of heterogeneous vancomycin intermediate methicillin resistant Staphylococcus aureus with vancomycin 4 g/ml Brain Heart Infusion Agar (hVISA), in the absence of vancomycin blood agar plates were cultured continuously cultured on MRSA medium, detection the change of vancomycin MIC value. Results of the 172 clinical isolates of Staphylococcus aureus to vancomycin in MIC (1.0~2.0) g/ml 146 strains, accounting for 84.89%; 102 strains of MRSA to vancomycin The value of MIC (1.0~2.0) g/ml in 88 strains, accounting for 86.27%, and two of them were MIC = (2.5~3.0) g/ml; 70 strains of vancomycin MSSA value in MIC (1.0~1.5) g/ml 46 strains, accounting for 65.71%, the remaining 1 mu g/ml; with vancomycin 4 g/ml brain heart infusion agar base is not screened for hVISA, also not screened for vancomycin MIC value of 8 g/ml VRSA; in vitro culture showed that the MRSA of vancomycin MIC value with the passage number showed some changes. Conclusion the detection rate of hVISA in Shenyang area is very low, may drift associated with strain MIC value failure of most clinical treatment, MIC value strains from antibiotics drift MIC environment serial passage, compared with the initial separation was decreased, suggesting that MIC value drift may be related to the genetic variation of stability, its mechanism needs further study.

【作者单位】：沈阳医学院附属沈州医院检验科;沈阳军区总医院检验科;
【基金】：辽宁省科技攻关计划基金资助项目(2011225021)
【分类号】：R515

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