甲氧西林耐药溶血葡萄球菌大环内酯类和林可酰胺类耐药基因型与表型分析_药学论文.docVIP

甲氧西林耐药溶血葡萄球菌大环内酯类和林可酰胺类耐药基因型与表型分析_药学论文 甲氧西林耐药溶血葡萄球菌大环内酯类和林可酰胺类耐药基因型与表型分析_药学论文 作者：吴伟元 潘小梅 卢月梅 吴劲松 程锦娥 甘志彪 李红林 陆坚 【摘要】 目的 研究甲氧西林耐药溶血葡萄球菌(MRSH)大环内酯类和林可酰胺类的耐药机制。方法 琼脂稀释法测定3种抗菌药对63株溶血葡萄球菌的最低抑菌浓度(MIC)，PCR技术检测mecA、ermA、ermB、ermC、msrA/msrB和linA/linA′耐药基因。结果 62株MRSH均携带mecA，最常见大环内酯类和林可酰胺类耐药基因为msrA/msrB(59.7%)，其次linA/linA′(50%)和ermC(32.3%)，50%菌株携带2种耐药基因，3.2%菌株携带3种耐药基因；21株携带erm均对红霉素高耐(MIC≥256μg/ml)，对克林霉素结构型MLSB或诱导型MLSB耐药；14株携带msrA/msrB对红霉素中度耐药(MIC=32或64μg/ml)；31株携带linA/linA′，3株对克林霉素耐药，其余均对克林霉素敏感。结论 MRSH携带msrA/msrB、linA/linA′和ermC基因是其对大环内酯类和林可酰胺类产生耐药的主要原因。 【关键词】 溶血葡萄球菌； 大环内酯类； 林可酰胺类； 耐药基因 ABSTRACT Objective To investigate the prevalence of resistance mechanisms against macrolides and lincosamides in methicillin inhibition concentration (MIC) of 3 antimicrobial agents against 63 strains of S.haemolyticus, and the resistance genes of mecA, ermA, ermB, ermC, msrA/msrB and linA/linA′ were anzlyzed by PCR in all clinical isolates. Result Among the 62 isolates of MRSH estimated by harboring the mecA gene, high occurrence of macrolides and lincosamides resistance genes msrA/msrB (59.7%), linA/linA′ (50%), and ermC (32.3%) were found; 50% of MRSH were detected harboring two different resistance genes, and 3.2% were detected harboring three; 21 strains with erm gene demonstrated high resistance to erythromycin (MIC≥256 μg/ml), and constitutive MLSB or inducible MLSB resistance to clindamycin; 14 isolates with msrA/msrB gene showed moderate resistance to erythromycin (MIC=32 or 64 μg/ml); 31 strains with linA/linA′ gene were all susceptible to clindamycin, with the except of three ones. Conclusion Resistance to macrolides and lincosamides in MRSH was mainly due to the presence of msrA/msrB, linA/linA′ and ermC genes. KEY WORDS Staphylococcus haemolyticus; Macrolides; Lincosamides; Resistance gene 大环内酯类和林可酰胺类是临床上治疗葡萄球菌感染常用的抗菌药。溶血葡萄球菌可通过ermA、ermB和ermC基因介导对大环内酯类、林可酰胺类和链阳菌素B耐药(MLSB耐药)，包括结构型和诱导型。该菌可通过主动外排(msrA或msrB基因介导)对大环内酯类和链阳菌素B耐药(MS耐药)，或利用林可霉素核苷转移酶(linA/linA′基因介导)灭活林可霉素和克林霉素(体外仅对林可霉素高耐