本文選題：甲氧西林耐藥金黃色葡萄球菌 + 基因分型��； 參考：《浙江大學(xué)》2015年碩士論文

【摘要】：背景及意義甲氧西林耐藥的金黃色葡萄球菌(methicillin-resistant Staphylococcus aureus,MRSA)是指對苯唑西林、甲氧西林、和氟氯西林等異唑青霉素耐藥的金黃色葡菌球菌菌株,于1961年由Jevons首次發(fā)現(xiàn),是引起醫(yī)院感染的重要病原菌之一。其傳播速度快,適應(yīng)性強(qiáng),從發(fā)現(xiàn)至今,感染幾乎遍及全球。具有多重耐藥性和潛在的致死性等特點,存在局部暴發(fā)流行的潛在威脅。我國自20世紀(jì)70年代發(fā)現(xiàn)第1株MRSA后,其分離率在中國迅速上升。目前MRSA已成為醫(yī)院和社區(qū)人群感染的常見病原菌,不但致病能力強(qiáng),耐藥譜廣,而且對多種抗菌藥物的敏感性呈現(xiàn)逐年降低趨勢,已經(jīng)成為嚴(yán)重危害公眾健康的感染性因子之一,使臨床抗感染治療面臨極大困難,由此也成為醫(yī)學(xué)界關(guān)注的焦點問題。該菌對目前臨床上使用的大多數(shù)抗菌藥物有很高的耐藥率,并可對β內(nèi)酰胺類、氨基糖苷類、喹諾酮類、大環(huán)內(nèi)酯類等常用抗菌藥物產(chǎn)生多重耐藥。臨床可供選擇的抗生素較少,是目前抗感染治療的難點。當(dāng)前基因分型的分子流行病學(xué)研究方法在揭示病原菌的進(jìn)化及遺傳特性,確定某一感染暴發(fā)流行的致病菌株克隆或相關(guān)基因來源,追蹤基因水平的轉(zhuǎn)移與播散,調(diào)查院內(nèi)耐藥性質(zhì)粒在不同細(xì)菌間播散等方面發(fā)揮重要作用。但截至目前國內(nèi)對MRSA系統(tǒng)全面的基因分型及分子學(xué)特性方面的研究較少,或片面不完整。本課題采用三種基因分型技術(shù)：多位點序列分型(MLST)、葡萄球菌染色體mec基因盒(SCCmec)和葡萄球菌蛋白A基因(spa),同時應(yīng)用脈沖場凝膠電泳(PFGE)對收集的菌株進(jìn)行同源性分析,PCR擴(kuò)增技術(shù)篩查菌株的pvl毒素基因,力求全面揭示我市MRSA流行株的具體基因型別及分子學(xué)特性。研究臨床分離MRSA的流行、藥物敏感性情況,有助于我們掌握本地區(qū)MRSA的流行特點及趨勢,為制定控制其傳播措施以及臨床經(jīng)驗性治療提供理論依據(jù)；開展對臨床分離MRSA的基因分型研究,了解本地區(qū)或某家醫(yī)院MRSA流行株的遺傳和基因分型特征,分析判斷流行菌株間的親緣關(guān)系,全面揭示MRSA流行株的基因型變化趨勢,藥敏及流行病學(xué)特點,有助于醫(yī)院或疾控部門采取有效措施控制感染的暴發(fā)流行,對于遏制流行菌株的進(jìn)一步播散和積極控制MRSA的感染以及指導(dǎo)臨床治療、合理應(yīng)用抗生素有著十分重要的意義。同時,開展對MRSA的相關(guān)研究,有利于提高基層臨床醫(yī)師對MRSA的知曉率,引起廣大醫(yī)務(wù)人員對其引起醫(yī)院感染的高度重視,嚴(yán)格執(zhí)行消毒隔離措施,積極治療并隔離MRSA患者及攜帶者,嚴(yán)格控制廣譜抗生素的應(yīng)用。目的研究杭州富陽區(qū)臨床分離的甲氧西林耐藥金黃色葡萄球菌(MRSA)的檢出率、藥敏情況及基因分型、同源性分析等分子學(xué)特性,分析富陽區(qū)MRSA的流行現(xiàn)狀。方法收集2013年11月至2014年10月兩家醫(yī)院從各種類型臨床標(biāo)本中分離出的金葡菌,對其中經(jīng)篩選確認(rèn)的44株MRSA進(jìn)行MLST、spa、SCCmec基因分型,篩查pvl基因,應(yīng)用PFGE進(jìn)行菌株間的同源性分析。同時應(yīng)用Vitek2 compact藥敏分析系統(tǒng)對16種抗菌藥物進(jìn)行藥敏實驗。結(jié)果共檢出MRSA44株,占金葡菌的16.4%(44/268)。兩家醫(yī)院流行的主要克隆不同,富陽中醫(yī)骨傷醫(yī)院以ST59-t437-SCCmecIV型為主,菌株間同源性程度低；人民醫(yī)院以ST5-t311-SCCmecⅡ型為主,部分菌株之間同源性程度高。檢出3株pvl陽性菌株,占6.8%。藥敏結(jié)果示MRSA對β內(nèi)酰胺類普遍耐藥,紅霉素、克林霉素的耐藥率高,對萬古霉素、利奈唑烷、替加環(huán)素保持敏感。結(jié)論富陽地區(qū)MRSA的檢出率相對較低,整體呈低流行、散發(fā)態(tài)勢。兩家醫(yī)院MRSA流行的主要克隆有較大差異。MRSA的耐藥情況不容樂觀,多重耐藥的現(xiàn)象嚴(yán)重。不同基因型別的菌株其藥敏結(jié)果有差異。
[Abstract]:Background and significance of methicillin resistant Staphylococcus aureus (methicillin-resistant Staphylococcus aureus, MRSA) is a strain resistant to oxacillin, methoxicillin, and fluroxicillin resistant Staphylococcus aureus, which was first discovered by Jevons in 1961. It is one of the important pathogens causing hospital infection. Fast and adaptable, from the discovery to the present, the infection is almost all over the world. It has the characteristics of multiple drug resistance and potential lethality, and there is a potential threat to local outbreak. Since the discovery of first MRSA strains in China in 1970s, its separation rate has risen rapidly in China. At present, MRSA has become a common cause of infection in hospitals and communities. Bacteria, which not only have strong pathogenicity, broad spectrum of drug resistance, but also reduce the sensitivity to a variety of antibiotics year by year. It has become one of the infectious factors that seriously harm public health. It has made clinical anti infection treatment face great difficulties, and it has become a focal point in medical field. Bacterial drugs have a high drug resistance rate and can produce multidrug resistance to antibiotics such as beta lactam, aminoglycosides, quinolones, macrolides and other commonly used antibiotics. The clinical selection of antibiotics is the difficult point of anti infection treatment. The current molecular epidemiology research method of genotyping is to reveal the evolution and inheritance of pathogenic bacteria. Characteristics, determine the clone or related gene source of a infectious outbreak, trace the transfer and dissemination of the gene level, and investigate the drug resistant plasmids in the hospital to play an important role in the spread of different bacteria. But at present, there are few studies on the comprehensive genotyping and genotyping of MRSA system in China. Three genotyping techniques: Multipoint sequence typing (MLST), staphylococcal chromosome mec gene box (SCCmec) and staphylococcal protein A gene (SPA) were used in this study. Meanwhile, pulse field gel electrophoresis (PFGE) was used to analyze the homology of the collected strains, and the PCR amplification technique was used to screen the PVL toxin gene of the strain. The specific genotypes and molecular characteristics of MRSA epidemic strains in our city are shown. The study of the prevalence of clinical isolation of MRSA and drug sensitivity can help us to grasp the epidemic characteristics and trends of MRSA in the region, provide theoretical basis for formulating the measures to control its transmission and clinical experiential treatment, and study the genotyping of the clinical isolates of MRSA. To understand the genetic and genotyping characteristics of MRSA epidemic strains in the local or certain hospitals, to analyze the relationship between the epidemic strains and to reveal the genotypic trend of the MRSA epidemic, the drug sensitivity and the epidemiological characteristics, which will help the hospital or the disease control department to take effective measures to control the outbreak of infection and to contain the epidemic strains. It is of great significance to further disseminate and actively control the infection of MRSA and to guide clinical treatment, and to apply antibiotics reasonably. At the same time, the study of MRSA is beneficial to the improvement of the awareness rate of MRSA by clinicians at the grass-roots level, and the attention of the medical staff to the hospital infection, and the strict implementation of the disinfection and isolation measures. To actively treat and isolate MRSA patients and carriers and strictly control the application of broad-spectrum antibiotics. Objective to study the detection rate of methicillin resistant Staphylococcus aureus (MRSA), drug sensitivity and genotyping, homology analysis of clinical isolates of methicillin resistant Staphylococcus aureus (MRSA) in Hangzhou District of Hangzhou Province, and to analyze the epidemic status of MRSA in the District of Fuyang. Methods collect 2013 methods. From November to October 2014, the two hospitals separated from various types of clinical specimens were isolated from various types of clinical specimens. 44 strains of MRSA, which were screened and confirmed, were divided into MLST, spa, SCCmec genotyping, the PVL gene was screened and PFGE was used to analyze the homology among the strains. Meanwhile, the drug sensitivity test of the 16 antibiotics was carried out by the Vitek2 compact drug sensitivity analysis system. Results a total of MRSA44 strains were detected, accounting for 16.4% (44/268) of Staphylococcus aureus. The main clones in two hospitals were different. The main hospital of Fuyang traditional Chinese medicine bone injury hospital was ST59-t437-SCCmecIV type, and the homology of the strains was low. The people's hospital was dominated by ST5-t311-SCCmec II type, and the homology was high among some strains. 3 PVL positive strains were detected, which accounted for 6.8%. drugs. The results showed that MRSA was generally resistant to beta lactam, the resistance rate of erythromycin and clindamycin was high, and vancomycin, linezolane and tigocycline were sensitive. Conclusion the detection rate of MRSA in Fuyang is relatively low, and the overall prevalence of MRSA in the two hospitals is low and the drug resistance of large difference.MRSA is not happy. Multidrug resistance is a serious phenomenon. The sensitivity of different genotypes is different.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R446.5

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相關(guān)期刊論文 前1條

1 趙銳;范欣;肖盟;王賀;熊祝嘉;毛鐳篥;張力;蔡晶;俞云松;;50株臨床分離金黃色葡萄球菌分子流行病學(xué)及藥物敏感性分析[J];中國感染與化療雜志;2013年01期

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本文編號：1984807