耐甲氧西林金黄色葡萄球菌对莫匹罗星、夫西地酸和瑞他莫林的耐药性分析

doi:10.3969/j.issn.1673-8640.2019.01.007

摘要/Abstract

摘要：

目的分析耐甲氧西林金黄色葡萄球菌（MRSA）临床菌株对局部抗菌药物莫匹罗星、夫西地酸和瑞他莫林的耐药情况。方法收集临床分离的1 037株MRSA,用微量肉汤稀释法测定其对莫匹罗星、夫西地酸和瑞他莫林的最小抑菌浓度（MIC）,筛选对3种抗菌药物耐药的菌株,用Vitek 2 Compact全自动微生物分析系统检测耐莫匹罗星、夫西地酸和瑞他莫林菌株对其他临床常用抗菌药物的耐药性。结果 1 037株MRSA中,有54株对莫匹罗星耐药（5.2%）,且以高水平耐药（MuH）为主（85.2%）;9株（0.9%）对夫西地酸耐药的MRSA菌株以低水平耐药（FAL）居多（77.8%）;仅2株（0.2%）对瑞他莫林耐药。对3种抗菌药物耐药的MRSA对氨基糖苷类、大环内酯类、林可酰胺类及氟喹诺酮类等临床常用抗菌药物也表现出较高的耐药率。结论临床分离的MRSA对莫匹罗星、夫西地酸、瑞他莫林等局部抗菌药物具有较低的耐药率,但少量耐药菌株的存在提示应加强金黄色葡萄球菌对该类药物的耐药性监测工作。

关键词: 耐甲氧西林金黄色葡萄球菌, 莫匹罗星, 夫西地酸, 瑞他莫林, 耐药性

Abstract:

Objective To investigate the drug resistance of methicillin-resistant Staphylococcus aureus （MRSA） to mupirocin,fusidic acid and retapamulin. Methods A total of 1 037 MRSA isolates were collected. The minimum inhibitory concentrations （MIC） of mupirocin,fusidic acid and retapamulin were determined by microbroth dilution method. The isolates resistant to 3 antibiotics were screened. The drug resistance of MRSA to mupirocin,fusidic acid and retapamulin was determined by Vitek 2 Compact analyzer. Results Among the 1 037 MRSA isolates,54 （5.2%） MRSA isolates were resistant to mupirocin,and 85.2% of them were high-level mupirocin resistance（MuH）. Among 9 （0.9%） fusidic acid resistant MRSA isolates,77.8% of them were low-level fusidic acid resistance（FAL）. The proportion of retapamulin resistant MRSA isolates was the lowest （0.2%）. The MRSA isolates,which were resistant to mupirocin,fusidic acid and retapamulin,were also highly resistant to aminoglycosides,macrolides,lincosamides and fluoroquinolones. Conclusions Low mupirocin,fusidic acid and retapamulin resistance in MRSA isolates is found. The existence of a small amount of drug resistant isolates suggests that it should strengthen the determination and surveillance of the drug resistance of Staphylococcus aureus.

Key words: Methicillin-resistant Staphylococcus aureus, Mupirocin, Fusidic acid, Retapamulin, Drug resistance

中图分类号:

R378.1

陈雯静, 何春燕, 杨涵, 赵焕强, 崔泽林, 汤荣, 刘庆中. 耐甲氧西林金黄色葡萄球菌对莫匹罗星、夫西地酸和瑞他莫林的耐药性分析[J]. 检验医学, 2019, 34(1): 33-37.

CHEN Wenjing, HE Chunyan, YANG Han, ZHAO Huanqiang, CUI Zelin, TANG Rong, LIU Qingzhong. Drug resistance of methicillin-resistant Staphylococcus aureus to mupirocin,fusidic acid and retapamulin[J]. Laboratory Medicine, 2019, 34(1): 33-37.

图/表 3

参考文献 19

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抗菌药物	MIC（μg/mL）	菌株数[株（%）]	耐药情况
莫匹罗星	<8	983（94.8）	S
	8	1（0.1）	MuL
	32	2（0.2）	MuL
	64	1（0.1）	MuL
	128	3（0.3）	MuL
	256	1（0.1）	MuL
	512	8（0.8）	MuH
	≥1 024	38（3.7）	MuH
夫西地酸	≤1	1 028（99.1）	S
	2	5（0.5）	MAL
	4	4（0.4）	MAL
	128	2（0.2）	FAH
瑞他莫林	<1	1 035（99.8）	S
	1	1（0.1）	R
	8	1（0.1）	R

抗菌药物	MIC（μg/mL）	菌株数[株（%）]	耐药情况
莫匹罗星	<8	983（94.8）	S
	8	1（0.1）	MuL
	32	2（0.2）	MuL
	64	1（0.1）	MuL
	128	3（0.3）	MuL
	256	1（0.1）	MuL
	512	8（0.8）	MuH
	≥1 024	38（3.7）	MuH
夫西地酸	≤1	1 028（99.1）	S
	2	5（0.5）	MAL
	4	4（0.4）	MAL
	128	2（0.2）	FAH
瑞他莫林	<1	1 035（99.8）	S
	1	1（0.1）	R
	8	1（0.1）	R

抗菌药物	莫匹罗星耐药MRSA				夫西地酸耐药MRSA				瑞他莫林耐药MRSA 总耐药率（2株）
抗菌药物	总耐药率（54株）	MuH （46株）	MuL （8株）	P值^*	总耐药率（9株）	FAH （2株）	FAL （7株）	P值^#	瑞他莫林耐药MRSA 总耐药率（2株）
庆大霉素	83.33	86.96	62.50	0.118	44.44	50.00	42.86	1.000	100.00
四环素	92.59	93.48	87.50	0.484	44.44	100.00	28.57	0.167	100.00
克林霉素	92.59	91.30	100.00	1.000	55.56	100.00	42.86	0.444	100.00
红霉素	94.44	93.48	100.00	1.000	88.89	100.00	85.71	1.000	100.00
环丙沙星	92.59	93.48	87.50	0.484	66.67	100.00	57.14	0.500	100.00
左氧氟沙星	96.30	95.65	100.00	1.000	66.67	100.00	57.14	0.500	100.00
莫西沙星	94.44	95.65	87.50	0.388	55.56	100.00	42.86	0.444	100.00
复方磺胺甲噁唑	5.56	4.35	12.50	0.388	0.00	0.00	0.00		0.00
利福平	1.85	2.17	0.00	1.000	11.11	0.00	14.29	1.000	0.00
呋喃妥因	0.00	0.00	0.00		0.00	0.00	0.00		0.00
利奈唑胺	0.00	0.00	0.00		0.00	0.00	0.00		0.00
万古霉素	0.00	0.00	0.00		0.00	0.00	0.00		0.00

抗菌药物	莫匹罗星耐药MRSA				夫西地酸耐药MRSA				瑞他莫林耐药MRSA 总耐药率（2株）
抗菌药物	总耐药率（54株）	MuH （46株）	MuL （8株）	P值^*	总耐药率（9株）	FAH （2株）	FAL （7株）	P值^#	瑞他莫林耐药MRSA 总耐药率（2株）
庆大霉素	83.33	86.96	62.50	0.118	44.44	50.00	42.86	1.000	100.00
四环素	92.59	93.48	87.50	0.484	44.44	100.00	28.57	0.167	100.00
克林霉素	92.59	91.30	100.00	1.000	55.56	100.00	42.86	0.444	100.00
红霉素	94.44	93.48	100.00	1.000	88.89	100.00	85.71	1.000	100.00
环丙沙星	92.59	93.48	87.50	0.484	66.67	100.00	57.14	0.500	100.00
左氧氟沙星	96.30	95.65	100.00	1.000	66.67	100.00	57.14	0.500	100.00
莫西沙星	94.44	95.65	87.50	0.388	55.56	100.00	42.86	0.444	100.00
复方磺胺甲噁唑	5.56	4.35	12.50	0.388	0.00	0.00	0.00		0.00
利福平	1.85	2.17	0.00	1.000	11.11	0.00	14.29	1.000	0.00
呋喃妥因	0.00	0.00	0.00		0.00	0.00	0.00		0.00
利奈唑胺	0.00	0.00	0.00		0.00	0.00	0.00		0.00
万古霉素	0.00	0.00	0.00		0.00	0.00	0.00		0.00