台湾某医院耐甲氧西林金黄色葡萄球菌和万古霉素中介金黄色葡萄球菌的克隆传播。
Clonal dissemination of meticillin-resistant and vancomycin-intermediate Staphylococcus aureus in a Taiwanese hospital.
机构信息
Departments of Laboratory Medicine and Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
出版信息
Int J Antimicrob Agents. 2010 Oct;36(4):307-12. doi: 10.1016/j.ijantimicag.2010.06.035. Epub 2010 Aug 3.
Meticillin-resistant and vancomycin-intermediate Staphylococcus aureus (VISA) has emerged worldwide. However, clonal dissemination of VISA in hospitals has rarely been reported. We investigated 43 isolates of meticillin-resistant VISA [vancomycin minimum inhibitory concentrations (MICs) of 4 microg/mL in 35 isolates and 8 microg/mL in 8 isolates) recovered from 21 hospitalised patients. A glycopeptide was given prior to isolation of VISA in 14 of the patients. Five patients (23.8%) died despite vancomycin therapy. All isolates were inhibited by tigecycline at 0.5 microg/mL, linezolid at 1 microg/mL and ceftobiprole at 2 microg/mL. Five isolates (11.6%) had reduced susceptibility to daptomycin (MICs of 1-2 microg/mL). In addition, 6 of the 43 VISA isolates had decreased susceptibility to autolysis by 0.05% Triton X-100. All 43 VISA isolates carried staphylococcal chromosome cassette mec (SCCmec) type III and accessory gene regulator (agr) group I but none carried the Panton-Valentine leukocidin gene (lukS-lukF). None of the enterococcal van genes were detected in the 43 VISA isolates. Molecular typing generated by pulsed-field gel electrophoresis revealed that all isolates belonged to one pulsotype, indicating clonal dissemination of VISA isolates in the hospital. The high rate of non-susceptibility to daptomycin amongst these VISA isolates is alarming and indicates the limitation of this agent for the treatment of infections due to VISA.
耐甲氧西林和万古霉素中介金黄色葡萄球菌(VISA)已在全球范围内出现。然而,医院内 VISA 的克隆传播很少有报道。我们调查了 21 名住院患者中分离出的 43 株耐甲氧西林 VISA(万古霉素最小抑菌浓度(MIC)为 4μg/ml 的有 35 株,8μg/ml 的有 8 株)。在 14 例患者中,在分离出 VISA 之前曾使用糖肽类药物。尽管给予了万古霉素治疗,但仍有 5 例患者(23.8%)死亡。所有分离株均被替加环素(MIC 为 0.5μg/ml)、利奈唑胺(MIC 为 1μg/ml)和头孢噻肟(MIC 为 2μg/ml)抑制。有 5 株(11.6%)分离株对达托霉素的敏感性降低(MIC 值为 1-2μg/ml)。此外,43 株 VISA 分离株中有 6 株对 0.05% Triton X-100 的自溶作用的敏感性降低。所有 43 株 VISA 分离株均携带葡萄球菌染色体盒 mec(SCCmec)类型 III 和辅助基因调节物(agr)组 I,但均不携带 Panton-Valentine 白细胞毒素基因(lukS-lukF)。在 43 株 VISA 分离株中均未检测到肠球菌的万古霉素基因。脉冲场凝胶电泳产生的分子分型显示,所有分离株均属于一个脉冲场型,表明医院内 VISA 分离株的克隆传播。这些 VISA 分离株对达托霉素的非敏感性率很高,令人警惕,表明该药物治疗 VISA 引起的感染存在局限性。