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目的研究中国儿童社区获得性耐甲氧西林金葡菌(CA-MRSA)肺炎分离株的多重耐药情况与克隆之间的关系。方法2006—2012年收集85株CA-MRSA分离株和50株医院获得性MRSA(HA-MRSA)分离株,进行多位点序列分型(MLST)和16种抗菌药物药敏试验,用脉冲场凝胶电脉(PFGE)和Southern印迹杂交定位莫匹罗星耐药基因mupA。结果 CA-MRSA和HA-MRSA对红霉素和克林霉素的耐药率较高,CA-MRSA对庆大霉素、四环素和利福平的耐药率低于HAMRSA(分别为36.5%和60.0%,P<0.01;34.1%和54.0%,P<0.05;8.2%和48.0%,P<0.01),对头孢呋辛、氯霉素和红霉素的耐药率高于HA-MRSA(100%和72.0%,P<0.01;22.3%和2.0%,P<0.01;87.0%和72.0%,P<0.05)。CAMRSA多重耐药率明显低于HA-MRSA。CA-MRSA多重耐药表型呈多样化,4种克隆(ST59、ST88、ST965和ST45)的多重耐药率高于50.0%。CA-MRSA中,1株对夫西地酸耐药,5株对莫匹罗星耐药,高水平莫匹罗星耐药基因mupA位于23~54.2 kb的质粒上。结论儿童CA-MRSA分离株对非β内酰胺类抗菌药物有较高的耐药率,并且多重耐药率和耐药谱与菌株克隆有关。
Objective To investigate the relationship between multidrug resistance and cloning of Chinese community-acquired community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) pneumonia isolates. Methods Eighty-five isolates of CA-MRSA and 50 isolates of hospital-acquired MRSA (HA-MRSA) were collected from 2006 to 2012 for multi-site sequence typing (MLST) and 16 antimicrobial drug susceptibility tests. Mapping mupirocin resistance gene mupA by gel electroporation (PFGE) and Southern blot hybridization. Results The resistance rates of erythromycin and clindamycin to CA-MRSA and HA-MRSA were higher than those of HAMRSA for CA-MRSA (36.5% And 60.0%, P <0.01; 34.1% and 54.0%, P <0.05; 8.2% and 48.0%, P <0.01). The resistance rate to cefuroxime, chloramphenicol and erythromycin was higher than that of HA-MRSA (100% and 72.0%, P <0.01; 22.3% and 2.0%, P <0.01; 87.0% and 72.0%, P <0.05). The multi-drug resistance rate of CAMRSA was significantly lower than that of HA-MRSA. The multidrug resistance phenotype of CA-MRSA was diversified. The multi-drug resistance rates of the four clones (ST59, ST88, ST965 and ST45) were higher than 50.0%. In CA-MRSA, 1 was resistant to fusidic acid, 5 was resistant to mupirocin, and the high mupir resistance gene mupA was located at 23-54.2 kb. Conclusion CA-MRSA isolates in children have higher resistance rate to non-β-lactam antibiotics, and the multi-drug resistance and drug resistance spectrum are related to the cloning of strains.