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目的分析风心病患者术后感染耐甲氧西林金黄色葡萄球菌SCCmec基因型别及耐药情况,为不同感染型别耐甲氧西林金黄色葡萄球菌的治疗提供指导。方法收集2015年1-12月风心病术后患者临床资料,对从患者临床标本中分离出的耐甲氧西林金黄色葡萄球菌进行SCCmec基因检测,K-B法分析不同基因型别菌株的耐药情况。结果63株耐甲氧西林金黄色葡萄球菌中,59株检测到SCCmecⅢ型基因,4株检测到SCCmecⅡ型基因。下呼吸道痰液标本分离耐甲氧西林金黄色葡萄球菌39株,其中携带SCCmecⅢ型基因37株,占94.87%,携带SCCmecⅡ型基因2株,占5.13%;血液标本分离18株,其中携带SCCmecⅢ型基因16株,占88.88%,携带SCCmecⅡ型基因2株,占11.12%;腹水以及伤口分泌物标本分别分离4和2株,均携带SCCmecⅢ型基因。携带SCCmecⅢ型基因的耐甲氧西林金黄色葡萄球菌对氨苄西林、左氧氟沙星、环丙沙星、庆大霉素、氯霉素和利福平等的耐药率分别为100.00%、49.15%、37.29%、33.90%、10.17%和8.47%,对万古霉素和利奈唑胺仍然敏感;携带SCCmecⅡ型基因的耐甲氧西林金黄色葡萄球菌对氨苄西林、左氧氟沙星、环丙沙星、庆大霉素、利福平的耐药率分别为100.00%、50.00%、25.00%、25.00%、25.00%,对氯霉素、万古霉素和利奈唑胺仍然敏感。结论耐甲氧西林金黄色葡萄球菌临床分离株基因型以SCCmecⅢ型为主,抗感染治疗时应首选万古霉素和利奈唑胺。
Objective To analyze the genotypes and drug resistance of methicillin-resistant Staphylococcus aureus SCCmec in patients with rheumatic heart disease and to provide guidance for the treatment of methicillin-resistant Staphylococcus aureus in different infection types. Methods The clinical data of patients with rheumatic heart disease from January to December in 2015 were collected. The SCCmec gene was detected in methicillin-resistant Staphylococcus aureus isolated from the clinical specimens of patients. KB was used to analyze the drug resistance of different genotypes . Results Among the 63 strains of methicillin-resistant Staphylococcus aureus, 59 strains of SCCmec Ⅲ were detected and 4 strains of SCCmec Ⅱ were detected. Thirty-nine isolates of methicillin-resistant Staphylococcus aureus were isolated from the lower respiratory tract sputum specimens, of which 37 strains were SCCmec type Ⅲ gene (94.87%), 2 strains were SCCmec Ⅱ type gene (5.13%), 18 were SCCmec type Ⅲ 16 strains (88.88%), 2 strains carrying SCCmec Ⅱ gene (11.12%), 4 and 2 isolates from ascites and wound secretions, all carrying SCCmec Ⅲ gene. The resistance rates of methicillin-resistant Staphylococcus aureus carrying SCCmec Ⅲ gene to ampicillin, levofloxacin, ciprofloxacin, gentamicin, chloramphenicol and rifampicin were 100.00%, 49.15%, 37.29% , 33.90%, 10.17% and 8.47%, respectively, were still sensitive to vancomycin and linezolid; methicillin-resistant Staphylococcus aureus carrying SCCmecⅡgene had no effect on ampicillin, levofloxacin, ciprofloxacin, The resistance rates of rifampicin were 100.00%, 50.00%, 25.00%, 25.00% and 25.00%, respectively, still sensitive to chloramphenicol, vancomycin and linezolid. Conclusion The genotypes of methicillin-resistant Staphylococcus aureus clinical isolates are mainly SCCmec type Ⅲ, vancomycin and linezolid should be the preferred anti-infective therapy.