早孕宫颈拭子166株表皮葡萄球菌耐药性与SCCmec分型

王恒伟 杨琳 郝民 邵希凤 宋衍燕

王恒伟, 杨琳, 郝民, 邵希凤, 宋衍燕. 早孕宫颈拭子166株表皮葡萄球菌耐药性与SCCmec分型[J]. 疾病监测, 2022, 37(5): 668-673. doi: 10.3784/jbjc.202109010476
引用本文: 王恒伟, 杨琳, 郝民, 邵希凤, 宋衍燕. 早孕宫颈拭子166株表皮葡萄球菌耐药性与SCCmec分型[J]. 疾病监测, 2022, 37(5): 668-673. doi: 10.3784/jbjc.202109010476
Wang Hengwei, Yang Lin, Hao Min, Shao Xifeng, Song Yanyan. Analysis on antibiotic resistance and staphylococcal chromosome cassette mec of 166 strains of Staphylococcus epidermidis isolating from early pregnancy cervical swabs[J]. Disease Surveillance, 2022, 37(5): 668-673. doi: 10.3784/jbjc.202109010476
Citation: Wang Hengwei, Yang Lin, Hao Min, Shao Xifeng, Song Yanyan. Analysis on antibiotic resistance and staphylococcal chromosome cassette mec of 166 strains of Staphylococcus epidermidis isolating from early pregnancy cervical swabs[J]. Disease Surveillance, 2022, 37(5): 668-673. doi: 10.3784/jbjc.202109010476

早孕宫颈拭子166株表皮葡萄球菌耐药性与SCCmec分型

doi: 10.3784/jbjc.202109010476
详细信息
    作者简介:

    王恒伟,男,安徽省宿州市人,副主任技师,从事病原微生物检验和研究工作,Email:wanghw999@126.com

    通讯作者:

    宋衍燕,Tel:010–67773642,Email:songyanyancdc@163.com

  • 中图分类号: R211;R117

Analysis on antibiotic resistance and staphylococcal chromosome cassette mec of 166 strains of Staphylococcus epidermidis isolating from early pregnancy cervical swabs

More Information
  • 摘要:   目的   了解2015-2017年从北京市朝阳区早孕宫颈拭子中分离的166株表皮葡萄球菌耐药性与耐药基因携带情况以及葡萄球菌染色体mec盒(SCCmec)型别,为合理用药及预防感染提供依据。  方法  回顾性分析2015-2017年从北京市朝阳区早孕宫颈拭子中分离的166株表皮葡萄球菌耐药情况,分别采用K-B法对头孢西丁,微量肉汤稀释法对其他11种抗菌药物进行药敏试验,采用聚合酶链式反应(PCR)对红霉素类、喹诺酮类、磺胺类、氨基糖苷类、大环内酯类、四环素类耐药基因和SCCmec的基因型和亚型进行检测,使用SPSS 22.0软件,用χ2检验对表皮葡萄球菌耐药率和耐药基因携带情况进行统计分析。  结果  166株表皮葡萄球菌药敏试验结果对万古霉素100.00% 敏感、对达托霉素93.37% 敏感,对青霉素、苯唑西林、红霉素的耐药率在90%以上,对其他抗菌药物均有不同程度的耐药;多重耐药比例为72.89%;mecA基因携带率45.78%;耐药基因携带率以norA1(100.00%)和norA2(95.78%)较高,其次为msrA(71.08%);76株mecA阳性表皮葡萄球菌中,以SCCmecⅢ型(40.79%)为主,其次为SCCmecⅤ型(22.37%)。  结论  健康人群早孕宫颈拭子表皮葡萄球菌的携带率超过50%,耐甲氧西林的表皮葡萄球菌菌株比例达24.70%,有必要回溯往期孕期妇女宫颈分泌物携带菌株分型及耐药情况,对多重耐药菌株需长期加大抗生素监管,以减少耐药菌株产生,降低新生儿败血症感染风险。
  • 表  1  表皮葡萄球菌14种耐药基因引物序列

    Table  1.   Primer sequences of 14 drug-resistant genes of S. epidermis

    基因序列号引物序列(5′~3′)片段大小(bp)
    ermAX03216F:GTTCAAGAACAATCAATACA421
    R:GGATCAGGAAAAGGACATTT
    ermBM17790F:AAGGGCATTTAAGGACGAA425
    R:ATCTGTGGTATGGCGGGTAAG
    ermCM17790F:ATGCAAAACTACAGAAAATAAAC247
    R:TAAAAATAATGCCAATGAGC
    msrAX52085F:GGCACAATAAGAGTGTTTAA940
    R:AAGTTATATCATGAATAGATTGTCCTGTT
    norA1AY566250F:TATTATCGGTGGAGGCGTGTTTG432
    R:TTTGCTTCTTTACGGCGTGACTT
    norA2AY566250F:GTTTATACAGATGTGAAAGCGAAGA392
    R:CAGGAATAACTAATCCAATCCCTAA
    sul1CP021289.1F:CATTGCCTGGTTGCTTCAT238
    R:ATCCGACTCGCAGCATTT
    sul2CP023145.1F:CATCATTTTCGGCATCGTC793
    R:TCTTGCGGTTTCTTTCAGC
    sul3LT906556.1F:AGATGTGATTGATTTGGGAGC443
    R:TAGTTGTTTCTGGATTAGAGCCT
    aac(6′)/aph(2′′)KX712118.1F:CCAAGAGCAATAAGGGCATA220
    R:CACTATCATAACCACTACCG
    ant(4′,4′′)LT571449.1F:GCAAGGACCGACAACATTTC165
    R:TGGCACAGATGGTCATAACC
    ant(6)KX712118.1F:ACTGGCTTAATCAATTTGGG597
    R:GCCTTTCCGCCACCTCACCG
    tetMKT281947.1F:GTGTGACGAACTTTACCGAA501
    R:GCTTTGTATCTCCAAGAACAC
    mecAY006688F:TCCAGATTACAACTTCACCAGG162
    R:CCACTTCATATCTTGTAACG
    下载: 导出CSV

    表  2  166株表皮葡萄球菌11种抗生素药物敏感试验结果

    Table  2.   Drug susceptibility test for 166 strains of S.epidermidis

     抗生素耐药菌株数耐药率(%)
    万古霉素00.00
    达托霉素116.63
    氯霉素2012.05
    庆大霉素3018.07
    环丙沙星5030.12
    四环素5331.93
    复方新诺明6337.95
    克林霉素6639.76
    红霉素15090.36
    苯唑西林15090.36
    青霉素15291.57
    下载: 导出CSV

    表  3  表皮葡萄球菌mecA阳性与mecA阴性组菌株对抗菌药物耐药情况比较

    Table  3.   Comparison of 76 mecA positive S. epidermidis strains and 90 mecA negative S. epidermidis strains

    抗菌药物mecA阳性组(76株)mecA阴性组(90株)χ2P
    耐药株数耐药率(%)耐菌株数耐药率(%)
    庆大霉素1925.001112.224.5440.027
    红霉素6788.168392.220.7820.267
    氯霉素1013.161011.110.1630.433
    复方新诺明4153.952224.4415.231<0.001
    克林霉素3546.053134.448.5330.003
    环丙沙星3444.741617.7814.228<0.001
    四环素2532.892831.110.0600.468
    青霉素7598.687785.569.1970.002
    苯唑西林7598.687583.3311.1490.001
    头孢西丁4153.942831.118.8470.002
    下载: 导出CSV

    表  4  耐甲氧西林与甲氧西林敏感表皮葡萄球菌对抗菌药物耐药情况比较

    Table  4.   Antimicrobial resistance of 41 MRSE strains and 125 methicillin sensitive strains

    抗菌药物耐甲氧西林表皮葡萄球菌(41株)甲氧西林敏感表皮葡萄球菌(125株)χ2P
    耐药株数耐药率(%)耐药株数耐药率(%)
    庆大霉素1536.591512.0012.6040.001
    红霉素4097.5611088.003.2400.058
    氯霉素512.201512.000.0000.582
    复方新诺明41100.002217.6086.110<0.001
    克林霉素2560.984132.8010.2330.001
    环丙沙星1843.903225.604.9140.023
    四环素1843.903528.003.5920.046
    青霉素41100.0011188.802.3960.052
    苯唑西林4097.5611088.002.2360.058
    下载: 导出CSV

    表  5  166株表皮葡萄球菌14种耐药基因携带情况

    Table  5.   Carriage of resistance genes to 14 antibiotics of 166 S. epidermidis strains

    耐药基因菌株数携带率(%)
    norA1166100.00
    norA215995.78
    msrA11871.08
    mecA7645.78
    sul15834.94
    aac(6′)/aph(2′′)4124.70
    tetM3822.89
    ermC3018.07
    ant(4′,4′′)74.22
    sul263.61
    ermB53.01
    ant(6)31.81
    sul331.81
    ermA00.00
    下载: 导出CSV

    表  6  mecA阳性与阴性组间表皮葡萄球菌耐药基因携带情况

    Table  6.   Antibiotic resistance gene carriages in MecA positive and negative S. epidermidis strains

    耐药基因mecA阳性组(76株)mecA阴性组(90株)χ2P
    菌株数携带率(%)菌株数携带率(%)
    ermC1621.051415.560.8410.237
    ermB33.9422.220.0370.420
    ant(6)33.9400.001.2070.137
    sul13546.052325.567.6150.005
    sul333.9400.001.2070.137
    norA27294.748796.670.0520.407
    ant(4′,4′′)67.8911.113.1650.036
    sul256.5811.112.1410.071
    tetM2330.261516.674.3150.029
    aac(6′)/aph(2′′)2532.891617.785.0630.019
    msrA4761.847178.895.8250.012
      注:166株表皮葡萄球菌耐药基因norA1携带率为100.00%,ermA均未检出,mecA为其阳性与阴性比较,故未再列入上表进行分析
    下载: 导出CSV

    表  7  耐甲氧西林与甲氧西林敏感表皮葡萄球菌耐药基因携带情况

    Table  7.   Carriage of drug-resistant genes of 41 MRSE strains and 125 methicillin sensiitive strains

    耐药基因耐甲氧西林表皮葡萄球菌(41株)甲氧西林敏感表皮葡萄球菌(125株)χ2P
    菌株数携带率(%)菌株数携带率(%)
    norA23892.6812196.801.2960.234
    sul12970.732923.2030.6840.000
    msrA2151.229072.006.0180.013
    aac(6′)/aph(2′′)2048.782116.8016.978<0.001
    tetM1741.462116.8010.6390.002
    ermC1126.831915.202.8200.077
    ant(4′,4′′)614.6310.8014.6290.001
    sul2512.2010.808.4690.004
    ant(6)37.3200.005.4490.015
    sul337.3200.005.4490.015
    ermB24.8832.400.0780.361
      注:166株表皮葡萄球菌耐药基因norA1携带率100.00%,ermA均未检出,mecA区分耐甲氧西林表皮葡萄球菌与甲氧西林敏感表皮葡萄球菌,故未再列入上表进行分析
    下载: 导出CSV
  • [1] Oza S, Lawn JE, Hogan DR, et al. Neonatal cause of death estimates for the early andlate neonatal periods for 194 countries: 2000–2013.[J]. Bull World Health Organ, 2015, 93(1): 19–28. DOI:  10.2471/BLT.14.139790.
    [2] Shobowale EO, Solarin AU,Elikwu CJ,et al. Neonatal sepsis in a Nigerian private tertiary hospital: Bacterial isolates, risk factors, and antibiotic susceptibility patterns[J]. Ann Afr Med, 2017, Apr-Jun;16(2): 52–58. DOI:  10.4103/aam.aam_34_16.
    [3] 文细毛, 徐秀华, 易霞云, 等. 我院母婴同室表皮葡萄球菌携带调查与质粒分析[J]. 中国微生态学杂志,1999,02:24–27. DOI: 10.13381/j.Cnki.cjm.1999.02.01.

    Wen XM, Xu XH, Yi XY, et al. Staphylococcus epidermidis in mothers and infants in our hospital[J]. Chin J Microecol, 1999, 02: 24–27. DOI:  10.13381/j.Cnki.cjm.1999.02.01.
    [4] Clinical and Laboratory Standards Instiute. M100-S27 Performance standands for antimicrobial susceptibility testing[S]. Wayne, PA, USA: CLSI, 2017.
    [5] 黄勋, 邓子德, 倪语星,等. 多重耐药菌医院感染预防与控制中国专家共识[J]. 中国感染控制杂志,2015,14(1):1–9. DOI:10.3969/j.issn.1671−9638.2015.01.001.

    Huang X, Deng ZD, Ni YX, et al. Chinese experts’consensus on prevention and control of multidrug resistance organism healthcare-associated infection[J]. Chin J Infect Control, 2015, 14(1): 1–9. DOI: 10.3969/j.issn.1671−9638.2015.01.001.
    [6] 李丽. 胎膜早破孕妇宫颈分泌物培养结果及分析[J]. 检验医学与临床,2009,1(2):15–17.

    Li L. Culture results and analysis of cervical secretions of pregnant women with premature rupture of membranes[J]. Lab med clin, 2009, 1(2): 15–17.
    [7] 卢江溢. 以呼吸窘迫为首发表现的新生儿早发型败血症临床特征[D]. 重庆: 重庆医科大学, 2016.

    Lu JY. The clinical characteristics of early-onset neonatal sepsis with respiratory distress as the first manifestation[D]. Chongqing: Chongqing Medical University, 2016.
    [8] Greenberg RG, Kandefer S, Do BT, et al. Late-onset sepsis in extremely premature infants: 2000–2011[J]. Pediatr Infect Dis J, 2017, 36(8): 774–779. DOI:  10.1097/INF.0000000000001570.
    [9] 周晋, 刘雪梅. 2015-2017年南京市儿童医院新生儿葡萄球菌的分布和耐药性分析[J]. 现代药物与临床, 2018, 33(12): 3388–3391. DOI: 10.7501/j. issn. 1674-5515.2018. 12.066.

    Zhou J, Liu XM. Analysis on distribution and drug resistance of neonatal staphylococcus in Nanjing Children's Hospital from 2015 to 2017[J]. Drug Clin , 2018, 33(12): 3388–3391. DOI: 10.7501/j. issn. 1674-5515.2018. 12.066.
    [10] 王光勇, 陈永刚, 周彬,等. 新生儿败血症临床致病菌的分布及其对抗菌药物的耐药性分析及治疗策略[J]. 抗感染药学,2019,16(4):590–594. DOI:10.13493/j.issn.1672−7878.2019.04−009.

    Wang GY, Chen YG, Zhou B, et al. Analysis on distribution and drug resistance of clinical pathogens of neonatal septicemia and its treatment strategies[J]. Anti Infect Pharm, 2019, 16(4): 590–594. DOI: 10.13493/j.issn.1672−7878.2019.04−009.
    [11] 全国细菌耐药监测网. 2014-2019年细菌耐药性监测报告[J]. 中国感染控制杂志,2021,20(1):15–30. DOI:10.12138/j.issn.1671−9638.20216170.

    China Antimicrobial Resistance Surveillance System. Antimicrobial resistance of bacteria: Surveillance report from China Antimicrobial Resistance Surveillance System in 2014–2019[J]. Chin J Infect Control, 2021, 20(1): 15–30. DOI: 10.12138/j.issn.1671−9638.20216170.
    [12] 付盼, 王传清, 余蕙, 等. 中国儿童细菌耐药监测组2017年儿童细菌感染及耐药监测[J]. 中国循证儿科杂志,2017,13(6):406–411. DOI:10.3969/j.issn.1673−5501.2018.06.002.

    Fu P, Wang CQ, Yu H, et al. Antimicrobial resistance profile of clinical isolates in pediatric hospitals in China: report from the ISPED Surveillance Program, 2017[J]. Chin J Evid Based Pediatr, 2017, 13(6): 406–411. DOI: 10.3969/j.issn.1673−5501.2018.06.002.
    [13] 杨蓉. 新生儿败血症274例病原菌分布及耐药性调查研究[J]. 陕西医学杂志,2019,48(8):1098–1101. DOI:10.3969/j.issn.1000−7377.2019.08.039.

    Yang R. Distribution and drug resistance of pathogens in 274 cases of neonatal septicemia[J]. Shanxi Med J, 2019, 48(8): 1098–1101. DOI: 10.3969/j.issn.1000−7377.2019.08.039.
    [14] 泰淑红, 王鹏, 邵艳, 等. 新生儿败血症病原学及耐药性情况分析[J]. 实践与检验医学,2017,35(4):461–463. DOI:10.3969/j.issn.1674−1129.2017.04.003.

    Tai SH, Wang P, Shao Y, et al. Drug Resistance Analysis and Distribution Characteristics of Pathogens in Neonatal Septicemia[J]. Exp lab Med, 2017, 35(4): 461–463. DOI: 10.3969/j.issn.1674−1129.2017.04.003.
    [15] 王芳, 杜坤, 蒋全. 2016-2019年淮南新华医疗集团新华医院新生儿科重症监护室感染性疾病病原菌分布及耐药性分析[J]. 现代药物与临床,2020,35(3):586–590. DOI:10.7501/j.issn.1674−5515.2020.03.041.

    Wang F, Du K, Jiang Q. Distribution and drug resistance of infectious diseases in intensive care unit of Department of Neonatology of Xinhua Medical Group Xinhua Hospital from 2016 to 2019[J]. Drug Clin, 2020, 35(3): 586–590. DOI: 10.7501/j.issn.1674−5515.2020.03.041.
    [16] Sun L, Sreedharan S, Plummer K, et al. NorA plasrnid resistance to fluoquinolones: role of copy number and norA frameshift mutations[J]. Antimicrob Agents Chemother, 1996, 40(7): 1665. DOI:  10.1128/AAC.40.7.1665.
    [17] Saber H, Jasni AS, Jamaluddin T, el a1. A Review of staphylococcal cassette chromosome mec(SCCmec) types in coagulase-negative staphylococci(CoNS) species[J]. Malays J Med Sci, 2017, 24(5): 7–18. DOI:  10.21315/mjms2017.24.5.2.
    [18] Chen XP, Li WG, Zheng H, et a1. Extreme diversity and multiple SCCmec elements in coagulase-negative Staphylococcus found in the clinic and community in Beijing, China[J]. Ann Clin Microbiol Antimierob, 2017, 16(1): 1–11. DOI: 10.1186/s12941−017−0231−z.
    [19] Enright MC, Robinson DA, Randle G, et al. The evolutionary history of methicillin-resistant Staphylococcus aureus(MRSA)[J]. Proc Natl Acad Sci USA‚2002‚99(11): 7687–7692. DOI:10.1073/pnas.122108599" target="_blank">10.1073/pnas.122108599">DOI:10.1073/pnas.122108599
    [20] Song YJ, Cui LQ, Yuan Lv, et al. Characterization of clinical isolates of oxacillin- susceptible mecA - positive Staphylococcus aureus in China from 2009 to 2014[J]. J Global Antimicrob Resist, 2017, 11: 1–3. DOI:  10.1016/j.jgar.2017.05.009.
    [21] Zhang KY, McClure JA, Elsayed S, et al. Novel staphylococcal cassette chromosome mec type, tentatively designated type Ⅷ, harboring class A mec and type 4 ccr gene complexes in a Canadian epidemic strain of methieillin resistant Staphylococcus aureus[J]. Antimicrob Agents Chemother, 2009, 53(2): 531–540. DOI: 10.1128/AAC.01118−08.
    [22] 熊玉玲, 夏小荣, 朱玉林, 等. 儿童感染耐甲氧西林凝固酶阴性葡萄球菌耐药性分析及葡萄球菌盒染色体mec分子流行病学调查研究[J]. 中华实用儿科临床杂志,2016,31(10):760–764. DOI:10.3760/cma.j.issn.2095−428X.2016.10.009.

    Xiong YL, Xia XR, Zhu YL, et al. Study on antibiotic resistance and Staphylococcus chromosomal cassette mec molecular epidemiology of methicillin resistant coagulase-negative in children[J]. Chin J Appl Clin Pediatr, 2016, 31(10): 760–764. DOI: 10.3760/cma.j.issn.2095−428X.2016.10.009.
    [23] Pinheiro L, Brito CI, Pereira VC, et al. Reduced susceptibility to vancomycin and biofilm formation in methicillin-resistant Staphylococcus epidermidis isolated from blood cultures[J]. Mem Inst Oswaldo Cruz. 2014, 109(7): 871–878. DOI: 10.1590/0074-0276140120
    [24] 吴泉, 邹伟华, 吴胜军, 等. 耐甲氧西林凝固酶阴性葡萄球菌SCCmec分子流行病学调查研究[J]. 中华医院感染学杂志,2013,23(8):1766–1768.

    Wu Q, Zou WH, Wu SJ, et al. Study on SCCmec molecular epidemiology of methicillin-resistant coagulase-negative Staphylococcu[J]. Chin J Nosocomiol, 2013, 23(8): 1766–1768.
    [25] 战晓微, 郑秋月. 耐甲氧西林金黄色葡萄球菌耐药性及SCCmec基因分型研究[J]. 国际检验医学杂志,2014,35(18):2512–2514. DOI:10.3969/j.issn.1673−4130.2014.18.038.

    Zhan XW, Zheng QY. Antimicrobial resistance and SCCmec genotype of methicillin-resistant Staphylococcus aureus[J]. Int J Lab Med, 2014, 35(18): 2512–2514. DOI: 10.3969/j.issn.1673−4130.2014.18.038.
    [26] 赵红梅, 彭新国, 纪冰, 等. 医院感染的金黄色葡萄球菌多重耐药机制研究[J]. 滨州医学院学报,2014,37(3):175–177.

    Zhao HM, Peng XG, Ji B, et al. Saphylococcus aureus resistance and resistance gene detection[J]. J Binzhou Med Univ, 2014, 37(3): 175–177.
  • 加载中
计量
  • 文章访问数:  139
  • HTML全文浏览量:  72
  • PDF下载量:  15
  • 被引次数: 0
出版历程
  • 收稿日期:  2021-09-01
  • 网络出版日期:  2022-01-25
  • 刊出日期:  2022-05-31

目录

    /

    返回文章
    返回

    在线交流

    防诈骗公告

    近期有不法分子以本刊编辑身份添加作者微信,请务必提高警惕!本刊关于稿件的一切事项通知均采用编辑部唯一邮箱(jbjc@icdc.cn)和座机(010-58900732)联系作者,且在录用稿件后仅收取版面费,无其他任何名目费用(如审稿费和加急费等),非编辑部邮箱发送的本刊收费用通知等均为诈骗,不要随意汇入款项!如有可疑及时致电编辑部核实确认!