本文選題：耐甲氧西林金黃色葡萄球菌　切入點(diǎn)：藥敏試驗(yàn)　出處：《寧夏醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的了解金黃色葡萄球菌(SAU)的臨床分布、標(biāo)本來(lái)源、抗菌藥物耐藥情況,并對(duì)耐甲氧西林金黃色葡萄球菌(MRSA)菌株和甲氧西林敏感金黃色葡萄球菌(MSSA)菌株的毒力基因進(jìn)行檢測(cè),能夠?yàn)轭A(yù)防醫(yī)院感染的發(fā)生、控制病原菌感染的擴(kuò)散、監(jiān)測(cè)醫(yī)院感染情況及臨床合理使用抗菌藥物提供科學(xué)的指導(dǎo)。方法收集醫(yī)院2015年7月-2016年7月從臨床標(biāo)本中的金黃色葡萄球菌303株,將傳統(tǒng)手工方法與質(zhì)譜相結(jié)合鑒定至種。SAU的藥物敏感性試驗(yàn)采用紙片擴(kuò)散法(K-B法)進(jìn)行,并使用WHONET 5.6軟件對(duì)抗菌藥物的耐藥結(jié)果進(jìn)行分析。使用聚合酶鏈?zhǔn)椒磻?yīng)(PCR)法檢測(cè)51株MRSA和52株MSSA中mec A基因及腸毒素A(sea)、腸毒素B(seb)、殺白細(xì)胞素(pvl)、α-溶血素(hla)、纖維蛋白結(jié)合蛋白A(fnb A)毒力基因的分布情況,并使用SPSS 17.0軟件對(duì)MRSA與MSSA中毒力基因的檢出率進(jìn)行比較分析。結(jié)果303株SAU中MRSA為125株而MSSA為178株,兩者分別占41.3%和58.7%;SAU主要來(lái)自燒傷科、耳鼻喉科、神經(jīng)外科,其構(gòu)成比分別為15.2%、11.6%、10.6%;SAU主要來(lái)源于傷口分泌物和痰液,其構(gòu)成比分別為31.0%和30.7%。MRSA對(duì)青霉素G、頭孢呋辛、頭孢西丁、頭孢噻肟、頭孢唑林的耐藥率均為100%;MRSA和MSSA中未發(fā)現(xiàn)對(duì)萬(wàn)古霉素、替考拉寧和利奈唑胺耐藥的菌株。MRSA對(duì)阿米卡星、紅霉素、克林霉素、利福平、慶大霉素、四環(huán)素、環(huán)丙沙星、左氧氟沙星的耐藥率較高(48.0%);MSSA對(duì)紅霉素的耐藥率較高,其耐藥率為68.0%。51株MRSA和52株MSSA進(jìn)行mec A基因檢測(cè),MRSA中mec A基因的攜帶率為100%,而MSSA中mec A基因的攜帶率為0;對(duì)兩者進(jìn)行毒力基因sea、seb、hla、fnb A、pvl的檢測(cè),MRSA菌株和MSSA菌株中這些基因攜帶率分別為74.5%(38/51)、68.6%(35/51)、94.1%(48/51)、80.4%(41/51)、7.8%(4/51)和61.5%(32/52)、59.6%(31/52)、88.5%(46/52)、96.2%(50/51)、28.8%(15/52)。結(jié)論MRSA對(duì)β-內(nèi)酰胺類(lèi)抗菌藥物的耐藥率非常高,并對(duì)大環(huán)內(nèi)酯類(lèi)、氨基糖苷類(lèi)、氟喹諾酮類(lèi)、林可霉素類(lèi)、四環(huán)素類(lèi)、復(fù)方新諾明等抗菌藥物有不同程度耐藥特性,MRSA對(duì)多種抗菌藥物的耐藥率普遍高于MSSA;MRSA和MSSA中未發(fā)現(xiàn)對(duì)萬(wàn)古霉素、替考拉寧和利奈唑胺耐藥的菌株。mec A基因只存在于MRSA中;毒力基因sea、seb、hla、fnb A、pvl在MRSA和MSSA中的攜帶率各不相同,毒力基因sea、seb和hla在兩者中的檢出率差異沒(méi)有統(tǒng)計(jì)學(xué)意義(P0.05),但毒力基因fnb A和pvl的檢出率差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。
[Abstract]:It can provide scientific guidance for the prevention of nosocomial infection, the control of the spread of pathogenic bacteria, the monitoring of nosocomial infection and the rational use of antimicrobial agents in clinic.Methods 303 strains of Staphylococcus aureus were collected from clinical samples from July 2015 to July 2016 in our hospital. The drug sensitivity test of traditional manual method combined with mass spectrometry was carried out by disk diffusion method and K-B method.The results of antimicrobial resistance were analyzed by WHONET 5. 6 software.Polymerase chain reaction (PCR) was used to detect the distribution of the virulence genes of mec A gene and enterotoxin Astragalus, enterotoxin Bransebr, leukocytoin, 偽 -hemolysin hlaa and fibrin binding protein A(fnb A in 51 MRSA and 52 MSSA strains.SPSS 17.0 software was used to compare the detection rate of MRSA and MSSA poisoning genes.Results among the 303 strains of SAU, 125 were MRSA and 178 were MSSA, which accounted for 41.3% and 58.7%, respectively, and mainly came from Burns, Otorhinolaryngology and Neurosurgery. The constituent ratio of MRSA and MSSA were 15.211.6% and 10.6%, respectively, which were mainly derived from wound secretions and sputum.The resistance rates of 30.7%.MRSA to penicillin G, cefuroxime, cefotaxime, cefotaxime and cefazolin were 31.0% and 31.0%, respectively.Erythromycin, clindamycin, rifampicin, gentamicin, tetracycline, ciprofloxacin, levofloxacin have higher resistance to erythromycin.The rate of drug resistance was 68.0.51 strains of MRSA and 52 strains of MSSA were tested for mec A gene. The carrying rate of mec A gene in MRSA was 100, while that of mec A gene in MSSA was 0. The virulence gene of mec A gene was detected by the virulence gene sea sebbhlahlahlafnb Apvl in MRSA strains and MSSA strains.Conclusion the resistance of MRSA to 尾 -lactam antibiotics is very high, and to macrolides, aminoglycosides, fluoroquinolones, lincomycin and tetracycline.The resistance rate of MRSA to multiple antimicrobial agents was higher than that of MSSA-MRSA and MSSA. The resistance of teicoplanin and linazolamide was only found in MRSA.
【學(xué)位授予單位】：寧夏醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R446.5

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