重症监护室医生鼻腔中高MRSA定植率的特性

Ikue Shamoto, Yuka Ishihara, M. Ohta
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摘要

背景:耐甲氧西林金黄色葡萄球菌(MRSA)是卫生保健相关感染的主要病原体。目的:调查某大学医院重症监护病房(ICU)医生鼻咽腔中金黄色葡萄球菌/MRSA的定植情况。方法:对2011年7月至2012年1月某大学附属医院ICU 29名医生进行鼻咽金黄色葡萄球菌/MRSA定植调查。聚合酶链反应(PCR)显示meca阳性菌株为MRSA。此外,还检测了分离株的抗菌敏感性和毒素基因谱。结果:第一次调查和第二次调查中分别有52%和64%的医生检出金黄色葡萄球菌定植,81%的分离株被确认为MRSA。经PCR检测,大多数MRSA菌株的mecA发生部分突变。除3株外,MRSA分离株对oxacillin敏感,这表明这些分离株可能在医院实验室中被误认为是对甲氧西林敏感的金黄色葡萄球菌(MSSA),而在oxacillin存在下再孵育3天后出现了几个耐药菌落。在MRSA分离株中,只有4株试验阳性,没有1株为eta/ eb阳性。结论:某大学医院ICU医师鼻腔MRSA定植率较高。通过mecA检测确定的大多数MRSA分离株对oxacillin敏感,但在oxacillin存在下产生耐药突变体。因此,我们强烈建议ICU医生监测和/或根除鼻腔内的MRSA定植。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Properties of a high rate of MRSA colonization in the nasal cavity of intensive care unit doctors
Background: Methicillin-resistant Staphylococcus aureus (MRSA) is a major causative agent of healthcare-associated infections. Aims: To survey S. aureus/MRSA colonization in the nasopharyngeal cavities of intensive care unit (ICU) doctors at a university hospital. Methods: Surveys on nasopharyngeal S. aureus/MRSA colonization in 29 ICU doctors at a university hospital were conducted during July 2011 and January 2012. Polymerase chain reaction (PCR) analysis revealed mecA-positive strains as MRSA. The antimicrobial susceptibilities and toxin gene profiles of the isolates were additionally examined. Results: A total of 52% of the doctors examined during the first survey and 64% during the second survey showed S. aureus colonization, and 81% of the isolates were confirmed to be MRSA. Most of the MRSA strains had partially mutated mecA, as determined by PCR. The MRSA isolates, except for three, were susceptible to oxacillin, suggesting that these isolates could be misidentified as methicillin-sensitive S. aureus (MSSA) in hospital laboratories, whereas several resistant colonies appeared after an additional 3 days of incubation in the presence of oxacillin. Among the MRSA isolates, only four were tst-positive, and none were eta/etb-positive. Conclusion: A high rate of MRSA colonization in the nasal cavity of ICU doctors at a university hospital was observed. Most MRSA isolates, as determined through mecA detection, were susceptible to oxacillin, but produced resistant mutants in the presence of oxacillin. Therefore, we strongly suggest monitoring and/or eradication of colonized MRSA in the nasal cavity of ICU doctors.
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