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目的了解甲状腺术后切口感染耐甲氧西林金黄色葡萄球菌(MRSA)耐药及耐药基因检测情况。方法收集2011-2014年长春地区医院甲状腺术后切口感染标本,采用西门子公司MicroScan WalkAway-40全自动微生物鉴定系统鉴定细菌,采用K-B法对MRSA进行药敏试验;提取细菌DNA,设计特异性基因进行PCR扩增。结果 2011-2014年共分离21株MRSA,对15种临床常用抗生素耐药率分别为:青霉素100%,阿莫西林95.24%,苯唑西林95.24%,氨卡西林100%,四环素71.43%,克林霉素80.95%,庆大霉素85.71%,头孢唑林100%,左氧氟沙星71.43%,莫西沙星38.1%,磺胺甲噁唑/甲氧苄啶42.86%,喹奴普汀/达福普汀4.76%,利福平38.10%,利奈唑胺4.76%,未检出万古霉素耐药菌株。21株MRSA中mecA、femA、16SrRNA和orfX基因检出率均为100%,hla阳性率为85.71%(18/21),icaA和clfB阳性率均为80.95%(17/21),aac(6′)/aph(2′′)阳性率为57.14%(12/21),hlg-2和pvl阳性率均为76.19%(16/21),clfA阳性率为71.43%(15/21),lukE阳性率为66.67%(14/21),ermC阳性率为52.38%(11/21),aac(3′)-Ⅲ阳性率为47.62%(10/21),ermA阳性率为28.57%(6/21),SasX和hlb阳性率均为23.81%(5/21),未检测到ermB基因。讨论MRSA是医院院内感染常见致病菌,喹奴普汀/达福普汀、利奈唑胺和万古霉素可用于长春地区MRSA感染的治疗。
Objective To investigate the drug resistance and drug resistance of methicillin-resistant Staphylococcus aureus (MRSA) in wounds after thyroidectomy. Methods The specimens of thyroidectomy incision in Changchun district hospital from 2011 to 2014 were collected. The bacteria were identified by Siemens MicroScan WalkAway-40 automatic microbe identification system and KB method was used to detect the susceptibility of MRSA. Bacterial DNA was extracted and specific genes were designed PCR amplification. Results A total of 21 strains of MRSA were isolated from 2011 to 2014. The rates of resistance to 15 commonly used antibiotics were: penicillin 100%, amoxicillin 95.24%, oxacillin 95.24%, ampicillin 100%, tetracycline 71.43% 80.95% for lincomycin, 85.71% for gentamicin, 100% for cefazolin, 71.43% for levofloxacin, 38.1% for moxifloxacin, 42.86% for sulfamethoxazole / trimethoprim, 4.76%, rifampicin 38.10%, linezolid 4.76%, vancomycin-resistant strains were not detected. The detection rates of mecA, femA, 16SrRNA and orfX gene in 21 strains of MRSA were 100%, the positive rate of hla was 85.71% (18/21), the positive rates of icaA and clfB were 80.95% (17/21), aac (6 The positive rates of hlg-2 and pvl were 76.19% (16/21) and 71.43% (15/21), respectively. The positive rates of lukE The positive rate of ermC was 52.38% (11/21), the positive rate of aac (3 ’) - Ⅲ was 47.62% (10/21), the positive rate of ermA was 28.57% (6 / 21). The positive rates of SasX and hlb were 23.81% (5/21), no ermB gene was detected. Discussion MRSA is a common nosocomial infection in hospital nosocomial infection, and quinipristin / dalfopristin, linezolid and vancomycin can be used for the treatment of MRSA infection in Changchun.