待產(chǎn)孕婦鼻腔金黃色葡萄球菌定植狀況及其危險(xiǎn)因素研究
發(fā)布時(shí)間：2018-09-05 09:57
【摘要】：目的了解深圳市龍華新區(qū)待產(chǎn)孕婦鼻腔金黃色葡萄球菌(Staphylococcus aureus)與耐甲氧西林金黃色葡萄球菌(Methicillin-resistant Staphylococcus aureus,MRSA)的定植狀況,探討影響鼻腔定植的危險(xiǎn)因素,并通過(guò)分析菌株的耐藥譜與分子生物學(xué)特征,為預(yù)防與控制產(chǎn)婦產(chǎn)后感染與新生兒感染提供科學(xué)依據(jù)。方法本研究根據(jù)橫斷面研究設(shè)計(jì),采用方便抽樣的方法選取深圳市龍華新區(qū)龍華中心醫(yī)院與觀瀾人民醫(yī)院于2015年8月至2015年11月入院待產(chǎn)的孕婦為調(diào)查對(duì)象,采用自制調(diào)查表對(duì)其進(jìn)行問(wèn)卷調(diào)查與鼻拭子采樣。根據(jù)一系列實(shí)驗(yàn)室標(biāo)準(zhǔn)方法進(jìn)行菌株的分離鑒定;采用K-B紙片對(duì)分離出的金黃色葡萄球菌進(jìn)行藥敏試驗(yàn);采用PCR技術(shù)檢測(cè)金黃色葡萄球菌特征性基因16S r RNA和nuc,MRSA特征性基因mec A,以及金葡菌攜帶的毒素基因pvl、tst、eta、etb,并對(duì)MRSA菌株進(jìn)行SCCmec分型。采用多位點(diǎn)測(cè)序技術(shù)(multilocus sequencing typing,MLST)對(duì)金葡菌進(jìn)行ST分型。數(shù)據(jù)統(tǒng)計(jì)采用Stata 13.0軟件進(jìn)行分析,危險(xiǎn)因素分析單因素分析、MSSA與MRSA耐藥率比較以及多重耐藥菌株與非多重耐藥菌株耐藥率比較采用χ2檢驗(yàn)或Fisher確切概率法,多因素分析采用Logistic回歸分析。采用e BURST V3軟件與樹(shù)狀圖分析軟件對(duì)本研究分離出的菌株之間,以及與國(guó)際流行菌株的親緣關(guān)系進(jìn)行分析。結(jié)果人口學(xué)特征:本研究共調(diào)查2172名待產(chǎn)孕婦,平均年齡為27.74±4.69周歲,以外地戶籍居多,占總體89.72%。家庭婦女占25.99%,工人與農(nóng)民占16.98%,醫(yī)務(wù)人員占1.48%,文職人員占35.11%,服務(wù)行業(yè)人員占9.34%,從事個(gè)體行業(yè)與其他行業(yè)者占11.10%。金葡菌與MRSA鼻腔定植率及其危險(xiǎn)因素:2172名調(diào)查對(duì)象中,有556名為金葡菌攜帶者,鼻腔定植率為25.60%,其中122名為MRSA攜帶者,總體定植率為5.62%。鼻腔定植金葡菌的單因素分析中,待產(chǎn)孕婦懷孕前BMI與金葡菌鼻腔定植之間的聯(lián)系有統(tǒng)計(jì)學(xué)意義(P=0.004)。在多因素分析中,消瘦者金葡菌定植風(fēng)險(xiǎn)為體重正常者的1.28倍(OR=1.28,P=0.027,95%CI:1.03-1.60);家庭婦女鼻腔金黃色葡萄球菌定植風(fēng)險(xiǎn)為工人與農(nóng)民的1.40倍(OR=0.1.40,P=0.035,95%CI:1.02-1.91)。MRSA定植的單因素分析中,不同職業(yè)者鼻腔MRSA定植率差異有統(tǒng)計(jì)學(xué)意義(P=0.005)。在多因素分析中,家庭婦女鼻腔MRSA定植風(fēng)險(xiǎn)為工人與農(nóng)民的2.19倍(OR=2.19,P=0.009,95%CI:1.21-3.96);有家庭成員在醫(yī)療機(jī)構(gòu)工作的待產(chǎn)孕婦鼻腔MRSA定植風(fēng)險(xiǎn)為無(wú)家庭成員在醫(yī)療機(jī)構(gòu)工作的待產(chǎn)孕婦的3.38倍(OR=3.38,P=0.025,95%CI:1.17-9.81)。金葡菌耐藥譜分析:金葡菌耐藥率最高的是青霉素(91.91%,511/556),其次為紅霉素(37.23%,207/556)和妥布霉素(21.22%,118/556);MRSA菌株耐藥率最高的是頭孢西丁(97.54%,111/122)、紅霉素(70.49%,86/122)和克林霉素(54.10%,66/122);MSSA菌株耐藥率最高的是青霉素(90.32%,392/434),其次為紅霉素(27.88%,121/434)和妥布霉素(21.20%,92/434)。MRSA對(duì)克林霉素、紅霉素、利福平、頭孢西丁和青霉素的耐藥率高于MSSA且具有統(tǒng)計(jì)學(xué)意義(P0.05);多重耐藥菌株在MRSA所占比重高于MSSA且差異具有統(tǒng)計(jì)學(xué)意義(P0.05);多重耐藥菌株對(duì)克林霉素、紅霉素、慶大霉素、莫西沙星、利奈唑胺、利福平、妥布霉素、替考拉寧、頭孢西丁、青霉素和磺胺甲惡唑的耐藥率均高于非多重耐藥菌株且差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。分子生物學(xué)特征:金葡菌pvl、eta、etb和tst毒素基因檢出率分別為4.50%、2.70%、0.18%和2.34%。MRSA pvl基因攜帶率(11.48%,14/122)高于MSSA(2.53%,11/434)且有統(tǒng)計(jì)學(xué)意義(P0.05)。MRSA菌株在SCCmec分型中Ⅱ型、Ⅲ型和Ⅳ型分別檢出率分別6.56%、10.66%和51.64%,另外有38株(31.15%)不可分型。556株金葡菌在MLST分型中發(fā)現(xiàn)存在84個(gè)ST型別其中ST188為主要型別(20.68%,115/556),其次為ST7(9.35%,52/556),ST6(7.73%,43/556)和ST59(7.73%,43/556)。MSSA菌株主要型別為ST188(23.73%,103/434),ST7(9.91%,43/434)和ST6(8.99%,39/434)。MRSA菌株主要型別為ST59(27.05%,33/122),其次為ST45(9.84%,12/122)、ST188(9.84%,12/122)和ST7(7.38%,9/122)。通過(guò)e BURST分析,84個(gè)ST分型屬于16個(gè)國(guó)際CC克隆群(CC5、CC7、CC10、CC12、CC20、CC22、CC30、CC45、CC59、CC88、CC121、CC882、CC398、CC672、CC1719和CC2483)和5個(gè)ST型別為單體(ST1046、ST198、ST1922、ST2540和ST2990)。通過(guò)聚類(lèi)分析發(fā)現(xiàn),醫(yī)院獲得性MRSA(HA-MRSA)ST型別與社區(qū)獲得性MRSA(CA-MRSA)ST型別存在聚合現(xiàn)象。結(jié)論深圳市龍華新區(qū)待產(chǎn)孕婦鼻腔金黃色葡萄球菌與MRSA的定植率較高;消瘦為鼻腔金葡菌定植的危險(xiǎn)因素,家庭成員在醫(yī)療機(jī)構(gòu)工作為鼻腔MRSA定植的危險(xiǎn)因素,家庭婦女為鼻腔金葡菌與MRSA定植的危險(xiǎn)因素;菌株對(duì)某些抗生素的耐藥率較高,多重耐藥情況較為嚴(yán)重;菌株毒素基因攜帶率較低。金葡菌ST型別復(fù)雜多樣,以ST188型別為主,醫(yī)院獲得性MRSA與社區(qū)獲得性MRSA共存且存在相互傳播的風(fēng)險(xiǎn)。
[Abstract]:Objective To investigate the colonization of Staphylococcus aureus and Methicillin-resistant Staphylococcus aureus (MRSA) in pregnant women in Longhua New District of Shenzhen City, and to explore the risk factors affecting nasal colonization. Methods According to the design of cross-sectional study, the pregnant women who were admitted to Longhua Central Hospital and Guanlan People's Hospital from August 2015 to November 2015 in Longhua New District of Shenzhen City were selected by convenient sampling method. A series of laboratory standard methods were used to isolate and identify the strains; K-B paper was used to test the drug sensitivity of the isolated Staphylococcus aureus; PCR was used to detect the 16S R RNA and NUC of the characteristic genes of Staphylococcus aureus, the MEC A of MRSA and the virus carried by Staphylococcus aureus. The gene pvl, tst, eta, ETB were typed by SCCmec. The multilocus sequencing typing (MLST) was used for the ST typing of Staphylococcus aureus. _2 test or Fisher's exact probability method were used to compare the drug resistance rate of the strains. Logistic regression analysis was used for multivariate analysis. The relationship between the isolates and the international epidemic strains was analyzed by using e-BURST V3 software and dendrogram analysis software. The average age of women was 27.74 [4.69], accounting for 89.72%. Family women accounted for 25.99%. Workers and farmers accounted for 16.98%. Medical workers accounted for 1.48%. Civilian workers accounted for 35.11%. Service workers accounted for 9.34%. Persons engaged in individual and other industries accounted for 11.10%. Staphylococcus aureus and MRSA nasal colonization rate and its risk factors: 2172 adjustments. Among the subjects, 556 were Staphylococcus aureus carriers and the nasal colonization rate was 25.60%. Among them, 122 were MRSA carriers and the overall colonization rate was 5.62%. In the univariate analysis of Staphylococcus aureus colonization in nasal cavity, the relationship between BMI and Staphylococcus aureus colonization in pregnant women before pregnancy was statistically significant (P = 0.004). The risk of implantation was 1.28 times higher than that of normal weight (OR = 1.28, P = 0.027, 95% CI: 1.03-1.60); the risk of Staphylococcus aureus colonization was 1.40 times higher in housewives than that of workers and peasants (OR = 0.1.40, P = 0.035, 95% CI: 1.02-1.91). There was significant difference in the rate of MRSA colonization among different occupations (P = 0.005). In the analysis, the risk of MRSA colonization was 2.19 times that of workers and farmers (OR = 2.19, P = 0.009, 95% CI: 1.21-3.96); the risk of MRSA colonization of pregnant women with family members working in medical institutions was 3.38 times that of pregnant women without family members working in medical institutions (OR = 3.38, P = 0.025, 95% CI: 1.17-9.81). Analysis: Penicillin (91.91%, 511/556) was the highest resistance rate of Staphylococcus aureus, followed by erythromycin (37.23%, 207/556) and tobramycin (21.22%, 118/556), cefoxitin (97.54%, 111/122), erythromycin (70.49%, 86/122) and clindamycin (54.10%, 66/122), and penicillin (90.32%, 392/434) was the highest resistance rate of MSSA. The resistance rates of MRSA to clindamycin, erythromycin, rifampicin, cefoxitin and penicillin were higher than those of MSSA (P 0.05). The proportion of multidrug resistant strains in MRSA was higher than that of MSSA and the difference was statistically significant (P 0.05). Molecular biological characteristics: Staphylococcus aureus pvl, eta, ETB and TST toxin gene detection rates were 4.50%, 2.70%, respectively. MRSA PVL gene carriers (11.48%, 14/122) were higher than MSSA (2.53%, 11/434) and had statistical significance (P 0.05). The main types of MSSA were ST188 (23.73%, 103/434), ST7 (9.91%, 43/434) and ST188 (23.73%, 103/434), ST7 (9.91%, 43/434) and ST6 (8.99%, 39/434). The main types of MRSAwere ST59 (27.05%, 33/122), ST45 (7.73%, 9.84%, 12/122), ST188 (23.73%, 103/434), ST7 (9.91%, 43/434) and ST6 (8.99%, 39/434). The main types of MRSAwere ST59 (27.05%, 33/122, ST45 (7.84%, 12/122), 188 (88 (23.73%, 103/122), 188 (188 (23.73%, 103/43/434), ST7 7.38%, 9/122). By e-BURST analysis, 84 ST genotypes belonged to 16 international CC clones (CC5, CC7, CC10, CC12, CC20, CC22, CC30, CC45, CC59, CC88, CC121, CC882, CC398, CC672, CC1719 and CC2483) and 5 ST-type monomers (ST1046, ST198, ST1922, ST2540 and ST2990). Cluster analysis revealed that hospital-acquired MRSA (HA-MRSA) ST types and community-acquired MRS (CA-MRS). Conclusion The colonization rate of Staphylococcus aureus and MRSA in pregnant women waiting for delivery in Longhua New District of Shenzhen City is high, wasting is a risk factor for the colonization of Staphylococcus aureus in nasal cavity, family members working in medical institutions is a risk factor for the colonization of MRSA in nasal cavity, and family women are a risk factor for the colonization of Staphylococcus aureus and MRSA in nasal cavity. The resistance rate of S. aureus strains to some antibiotics was high, and the multidrug resistance was serious, and the carrying rate of toxin gene was low.
【學(xué)位授予單位】：廣東藥科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R446.5;R714
本文編號(hào)：2223933
[Abstract]:Objective To investigate the colonization of Staphylococcus aureus and Methicillin-resistant Staphylococcus aureus (MRSA) in pregnant women in Longhua New District of Shenzhen City, and to explore the risk factors affecting nasal colonization. Methods According to the design of cross-sectional study, the pregnant women who were admitted to Longhua Central Hospital and Guanlan People's Hospital from August 2015 to November 2015 in Longhua New District of Shenzhen City were selected by convenient sampling method. A series of laboratory standard methods were used to isolate and identify the strains; K-B paper was used to test the drug sensitivity of the isolated Staphylococcus aureus; PCR was used to detect the 16S R RNA and NUC of the characteristic genes of Staphylococcus aureus, the MEC A of MRSA and the virus carried by Staphylococcus aureus. The gene pvl, tst, eta, ETB were typed by SCCmec. The multilocus sequencing typing (MLST) was used for the ST typing of Staphylococcus aureus. _2 test or Fisher's exact probability method were used to compare the drug resistance rate of the strains. Logistic regression analysis was used for multivariate analysis. The relationship between the isolates and the international epidemic strains was analyzed by using e-BURST V3 software and dendrogram analysis software. The average age of women was 27.74 [4.69], accounting for 89.72%. Family women accounted for 25.99%. Workers and farmers accounted for 16.98%. Medical workers accounted for 1.48%. Civilian workers accounted for 35.11%. Service workers accounted for 9.34%. Persons engaged in individual and other industries accounted for 11.10%. Staphylococcus aureus and MRSA nasal colonization rate and its risk factors: 2172 adjustments. Among the subjects, 556 were Staphylococcus aureus carriers and the nasal colonization rate was 25.60%. Among them, 122 were MRSA carriers and the overall colonization rate was 5.62%. In the univariate analysis of Staphylococcus aureus colonization in nasal cavity, the relationship between BMI and Staphylococcus aureus colonization in pregnant women before pregnancy was statistically significant (P = 0.004). The risk of implantation was 1.28 times higher than that of normal weight (OR = 1.28, P = 0.027, 95% CI: 1.03-1.60); the risk of Staphylococcus aureus colonization was 1.40 times higher in housewives than that of workers and peasants (OR = 0.1.40, P = 0.035, 95% CI: 1.02-1.91). There was significant difference in the rate of MRSA colonization among different occupations (P = 0.005). In the analysis, the risk of MRSA colonization was 2.19 times that of workers and farmers (OR = 2.19, P = 0.009, 95% CI: 1.21-3.96); the risk of MRSA colonization of pregnant women with family members working in medical institutions was 3.38 times that of pregnant women without family members working in medical institutions (OR = 3.38, P = 0.025, 95% CI: 1.17-9.81). Analysis: Penicillin (91.91%, 511/556) was the highest resistance rate of Staphylococcus aureus, followed by erythromycin (37.23%, 207/556) and tobramycin (21.22%, 118/556), cefoxitin (97.54%, 111/122), erythromycin (70.49%, 86/122) and clindamycin (54.10%, 66/122), and penicillin (90.32%, 392/434) was the highest resistance rate of MSSA. The resistance rates of MRSA to clindamycin, erythromycin, rifampicin, cefoxitin and penicillin were higher than those of MSSA (P 0.05). The proportion of multidrug resistant strains in MRSA was higher than that of MSSA and the difference was statistically significant (P 0.05). Molecular biological characteristics: Staphylococcus aureus pvl, eta, ETB and TST toxin gene detection rates were 4.50%, 2.70%, respectively. MRSA PVL gene carriers (11.48%, 14/122) were higher than MSSA (2.53%, 11/434) and had statistical significance (P 0.05). The main types of MSSA were ST188 (23.73%, 103/434), ST7 (9.91%, 43/434) and ST188 (23.73%, 103/434), ST7 (9.91%, 43/434) and ST6 (8.99%, 39/434). The main types of MRSAwere ST59 (27.05%, 33/122), ST45 (7.73%, 9.84%, 12/122), ST188 (23.73%, 103/434), ST7 (9.91%, 43/434) and ST6 (8.99%, 39/434). The main types of MRSAwere ST59 (27.05%, 33/122, ST45 (7.84%, 12/122), 188 (88 (23.73%, 103/122), 188 (188 (23.73%, 103/43/434), ST7 7.38%, 9/122). By e-BURST analysis, 84 ST genotypes belonged to 16 international CC clones (CC5, CC7, CC10, CC12, CC20, CC22, CC30, CC45, CC59, CC88, CC121, CC882, CC398, CC672, CC1719 and CC2483) and 5 ST-type monomers (ST1046, ST198, ST1922, ST2540 and ST2990). Cluster analysis revealed that hospital-acquired MRSA (HA-MRSA) ST types and community-acquired MRS (CA-MRS). Conclusion The colonization rate of Staphylococcus aureus and MRSA in pregnant women waiting for delivery in Longhua New District of Shenzhen City is high, wasting is a risk factor for the colonization of Staphylococcus aureus in nasal cavity, family members working in medical institutions is a risk factor for the colonization of MRSA in nasal cavity, and family women are a risk factor for the colonization of Staphylococcus aureus and MRSA in nasal cavity. The resistance rate of S. aureus strains to some antibiotics was high, and the multidrug resistance was serious, and the carrying rate of toxin gene was low.
【學(xué)位授予單位】：廣東藥科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R446.5;R714
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