目的 探討引起醫(yī)院獲得性肺炎( HAP) 的耐甲氧西林金黃色葡萄球菌( MRSA) 的基因多態(tài)性。方法 2007 年1 月至2008 年1 月上海交通大學(xué)醫(yī)學(xué)院附屬新華醫(yī)院住院診斷為醫(yī)院獲得性MRSA 肺炎患者74 例, 對所得82 株菌株進(jìn)行隨機(jī)擴(kuò)增DNA 的多態(tài)性( RAPD) 基因分型。結(jié)果 82 株MRSA經(jīng)電泳得到2 ～15 條片段, 經(jīng)聚類分析可分為11 個基因型。從重癥監(jiān)護(hù)室( ICU) 病例中分離所得的菌株, 主要為Ⅲ、Ⅵ型和Ⅶ型( 32. 56% 、30. 23% 和13. 95% ) 。從老年科、急診科和呼吸科病例中分離所得的菌株, 除有各自相對獨(dú)立的基因型外, 同時還有與ICU所得菌株重疊的基因型存在。其余臨床科室病例所分離的MRSA 菌株數(shù)量較少, 分布也較分散與獨(dú)立。暴發(fā)和聚集性病例共占48. 65% ( 36/ 74) , 所有暴發(fā)病例均發(fā)生于ICU 病區(qū)內(nèi)。結(jié)論 院內(nèi)獲得性MRSA 肺炎易于播散,特別是在ICU可發(fā)生小范圍的暴發(fā)。隨機(jī)擴(kuò)增DNA 的多態(tài)性分型對及早識別高危患者、預(yù)防MRSA在院內(nèi)的播散具有價值。
引用本文： 張靜,倪培華,劉瑛,郭雪君. 醫(yī)院獲得性肺炎的耐甲氧西林金黃色葡萄球菌基因多態(tài)性研究. 中國呼吸與危重監(jiān)護(hù)雜志, 2009, 09(5): 421-424. doi: 復(fù)制
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| 9. | Shimada K, Nakano K, Igari J, et al. Susceptibilities of bacteria isolated from patients with lower respiratory infectious diseases to antibiotics. Jpn J Antibiot, 2004, 54: 331-364. |
| 10. | Mackinnin MM, Allen KD. Long-term MRSA carriage in hospital patients. J Hosp Infect, 2000, 46: 216-221. |
| 11. | Fung CP, Ho MW, Wang FD, et al. Investigate of an outbreak caused by methicillin-resistant Staphylococcus aureus in a cardiovascular surgery unit by ribotyping, randomly amplified polymorphic DNA and pusled-field gel electrophoresis. APMIS, 2001, 109: 474-480. |
- 1. 俞森洋. 常見感染致病菌的耐藥機(jī)制及防治對策. 中國呼吸與危重監(jiān)護(hù)雜志, 2002, 1: 71-75.
- 2. 王秀香, 孫德俊, 郭宏, 等. 醫(yī)院內(nèi)肺部感染的病原菌及耐藥性分析. 中國呼吸與危重監(jiān)護(hù)雜志, 2003, 2: 308.
- 3. Gemmell CG, Edwards DI, Fraise AP, et al. Guidelines for the prophylaxis and treatment of methicillin-resistant Staphylococcus aureus ( MRSA ) infections in the UK. J Antimicrob Chemother, 2006, 57: 589-608.
- 4. Martin MC, Fueyo JM, Gonzalez Hevia MA, et al. Genetic procedures for identification of enterotoxigenic strains of Staphylococcus aureus from three food poisoning outbreaks. Int J Food Microbiol, 2004, 94: 279-286.
- 5. Hajo G, Satoshi H, Bob W, et al. Risk factors for the transmission of methicillin-resistant staphylococcus aureus in an adult intensive care unit: Fitting a model data. J Infect Dis, 2002, 185: 481-488.
- 6. 崔穎鵬, 徐鴻緒, 唐蕾, 等. 耐甲氧西林金黃色葡萄球菌基因多態(tài)性分型研究. 中國熱帶醫(yī)學(xué), 2007, 7: 1753-1754.
- 7. 高大威, 宋翠萍. 應(yīng)用RAPD 技術(shù)研究金黃色葡萄球菌和銅綠假單胞菌DNA 的多態(tài)性. 燕山大學(xué)學(xué)報, 2003, 27: 275-277.
- 8. Blanc DS, Francioli P, Le Coustumier A, et al. Reemergence of gentamicin-susceptible strains of methicillin-resistant Staphylococcus aureus in France: a phylogenetic approach. J Clin Microbiol, 2001 , 39: 2287-2290.
- 9. Shimada K, Nakano K, Igari J, et al. Susceptibilities of bacteria isolated from patients with lower respiratory infectious diseases to antibiotics. Jpn J Antibiot, 2004, 54: 331-364.
- 10. Mackinnin MM, Allen KD. Long-term MRSA carriage in hospital patients. J Hosp Infect, 2000, 46: 216-221.
- 11. Fung CP, Ho MW, Wang FD, et al. Investigate of an outbreak caused by methicillin-resistant Staphylococcus aureus in a cardiovascular surgery unit by ribotyping, randomly amplified polymorphic DNA and pusled-field gel electrophoresis. APMIS, 2001, 109: 474-480.