我国异质性万古霉素中介的金黄色葡萄球菌（hVISA）的发生率、分子流行病学及病例对照研究
发布时间：2019-01-02 08:07
【摘要】： 目的研究我国MRSA及血标本亚组中hVISA的发生率,并对琼脂筛选法和macroEtest(MET)法的敏感性和特异性做出评价。了解我国hVISA菌群体外药敏和分子流行病学特征。通过病例对照研究获得我国hVISA感染的相关临床信息并对危险因素和病死率相关性进行分析。 方法从6个组别收集来自全国范围的MRSA菌株共1012株,其中血标本MRSA 200株,其他类型标本MRSA 812株。使用BHIT5(含替考拉宁5μg/ml的脑心浸液琼脂平皿)、BHIV6(含万古霉素6μg/ml的脑心浸液琼脂平皿)和MET法对200株血标本MRSA进行hVISA/VISA筛选并使用改良PAP-AUC(菌群分析策略)法进行确认。对812株其他类型标本MRSA中BHIT5阳性者再进行MET法筛选。对血标本亚组的所有菌株进行含多种新型抗菌药物在内的体外药敏试验,并通过多重PCR方法进行SCCmec和agr分型。部分菌株进行spa分型。通过病例调查表(CRF)的形式收集hVISA组和对照组的临床相关信息,使用student t检验、Mann-Whitney检验、x~2检验以及fisher精确检验等统计方法对病例资料进行回顾性分析。 结果我国血标本中VISA的发生率为0.5%(1/200),hVISA的发生率为13.0%(27/200),hVISA/VISA的总发生率为13.5%。BHIT5的敏感性和特异性分别为88.8%和17.3%,BHIV6的敏感性和特异性分别为3.7%和98.8%;以MET MIC_(万古霉素)≥8μg/ml且METMIC_(替考拉宁)≥8μg/ml或MET MIC_(替考拉宁)≥12μg/ml为折点,MET A法的敏感性和特异性分别为70.4%和48.0%,以MET MIC_(万古霉素)≥8μg/ml且MET MIC_(替考拉宁)≥8μg/ml为折点,MET B法的敏感性和特异性分别为48.1%和85.0%。我国MRSA中hVISA的发生率估计为6.19%。200例血标本中,除一例VISA的万古霉素MIC为3μg/ml以外,其他hVISA的万古霉素MIC值仍在敏感范围内,且81.8%分布在万古霉素MIC=1μg/ml的水平,高于VSSA组且差异具有统计学意义(p=0.002)。hVISA对多种新一代抗菌药物如达托霉素、头孢吡普以及利奈唑胺均100%敏感。在分子流行病学方面,hVISA组中所占比例最高的是SCCmecⅢ型(70.4%)和agr1型(66.7%),其次为SCCmecⅡ型(22.2%)和agr2型(14.8%),VSSA组分子流行病学特征与hVISA组相似,两组间差异无统计学意义。病例对照研究未能得出hVISA与临床病死率具有相关性的结论。 结论我国hVISA的发生率较高。各种琼脂筛选方法的敏感性和特异性差别很大,以MET MIC_(万古霉素)＞18μg/ml且MET MIC_(替考拉宁)≥18μg/ml为折点的MET法可能具有较高的临床应用价值。hVISA组万古霉素MIC水平显著高于VSSA组,但多种新型抗菌药物对其具有良好活性。对hVISA临床意义的研究可能需要进行大样本的前瞻性队列研究。
[Abstract]:Objective to study the incidence of hVISA in MRSA and blood subgroups in China and to evaluate the sensitivity and specificity of Agar screening and macroEtest (MET). Objective: to investigate the drug sensitivity and molecular epidemiology of hVISA bacteria in China. The clinical information of hVISA infection in China was obtained by case-control study and the correlation between risk factors and mortality was analyzed. Methods A total of 1012 strains of MRSA were collected from 6 groups, including 200 strains of blood MRSA and 812 strains of other types of MRSA. BHIT5 (Agar plate containing 5 渭 g/ml teicoplanin) was used. BHIV6 (brain heart extract Agar plate containing vancomycin 6 渭 g/ml) and MET method were used to screen 200 blood samples for hVISA/VISA screening and confirmed by modified PAP-AUC (microflora analysis strategy) method. The BHIT5 positive cases of 812 other types of MRSA were screened by MET method. In vitro susceptibility tests were carried out to all strains of blood subgroup containing new antimicrobial agents, and SCCmec and agr typing were carried out by multiple PCR method. Some strains were classified by spa. The clinical data of hVISA group and control group were collected by case questionnaire (CRF), and the data were analyzed retrospectively by student t test, Mann-Whitney test, x2 test and fisher accurate test. Results the incidence of VISA in Chinese blood samples was 0.5% (1 / 200), hVISA, 13.0%, 27 / 200). The sensitivity and specificity of hVISA/VISA to 13.5%.BHIT5 were 88.8% and 17.3%, respectively. The sensitivity and specificity of BHIV6 were 3.7% and 98.8%, respectively. The sensitivity and specificity of, MET A with MET MIC_ 鈮，
本文编号：2398241
[Abstract]:Objective to study the incidence of hVISA in MRSA and blood subgroups in China and to evaluate the sensitivity and specificity of Agar screening and macroEtest (MET). Objective: to investigate the drug sensitivity and molecular epidemiology of hVISA bacteria in China. The clinical information of hVISA infection in China was obtained by case-control study and the correlation between risk factors and mortality was analyzed. Methods A total of 1012 strains of MRSA were collected from 6 groups, including 200 strains of blood MRSA and 812 strains of other types of MRSA. BHIT5 (Agar plate containing 5 渭 g/ml teicoplanin) was used. BHIV6 (brain heart extract Agar plate containing vancomycin 6 渭 g/ml) and MET method were used to screen 200 blood samples for hVISA/VISA screening and confirmed by modified PAP-AUC (microflora analysis strategy) method. The BHIT5 positive cases of 812 other types of MRSA were screened by MET method. In vitro susceptibility tests were carried out to all strains of blood subgroup containing new antimicrobial agents, and SCCmec and agr typing were carried out by multiple PCR method. Some strains were classified by spa. The clinical data of hVISA group and control group were collected by case questionnaire (CRF), and the data were analyzed retrospectively by student t test, Mann-Whitney test, x2 test and fisher accurate test. Results the incidence of VISA in Chinese blood samples was 0.5% (1 / 200), hVISA, 13.0%, 27 / 200). The sensitivity and specificity of hVISA/VISA to 13.5%.BHIT5 were 88.8% and 17.3%, respectively. The sensitivity and specificity of BHIV6 were 3.7% and 98.8%, respectively. The sensitivity and specificity of, MET A with MET MIC_ 鈮，
本文编号：2398241
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