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[临床金黄色葡萄球菌菌株中抗消毒剂抗性基因(qacA/B和smr)及抗生素抗性的流行情况]

[The prevalence of antiseptic resistance genes (qacA/B and smr) and antibiotic resistance in clinical Staphylococcus aureus strains].

作者信息

Nakipoğlu Yaşar, Iğnak Seyda, Gürler Nezahat, Gürler Bülent

机构信息

İstanbul University Faculty of İstanbul Medicine, Department of Medical Microbiology, İstanbul, Turkey.

出版信息

Mikrobiyol Bul. 2012 Apr;46(2):180-9.

Abstract

Staphylococcus aureus is an organism of major medical importance, leading to skin and soft tissue infections, bacteremia, and endocarditis. S.aureus isolates are becoming increasingly resistant to numerous antimicrobial agents including antiseptics and disinfectants. Quaternary ammonium compounds are disinfectants that play an important role in the control of nosocomial infections. Presence of genes conferring resistance to quaternary ammonium compounds is widely distributed among clinical staphylococci isolated from certain areas of the world. In this present study, we aimed to study the prevalence of antiseptic resistance genes (qac A/B, smr) and antibiotic resistance in clinical S.aureus strains, and also to detect the possible relationship between antiseptic and antibiotic resistance. For this purpose, the presence of qac A/B and smr genes in 50 methicillin-susceptible S.aureus (MSSA) and 50 methicillin-resistant S.aureus (MRSA) clinical isolates (78 abscess, 13 blood, 3 sputum, 3 tracheal aspirate, 2 nostril swab, 1 urine) was detected by using multiplex polymerase chain reaction. The susceptibility of S.aureus strains to different antibiotics (cefoxitin, erythromycin, clindamycin, rifampin, tetracycline, ciprofloxacin, gentamicin, trimethoprim-sulfamethoxazole, vancomycin, teicoplanin) was determined by disk diffusion method according to the recommendation of Clinical Laboratory Standards Institute (CLSI). smr genes were found in 18 (36%) of 50 MRSA and qacA/B genes in 2 (4%) of 50 MSSA strains. Presence of smr gene only in MRSA strains in comparison to MSSA strains was found to be statistically significant (p< 0.001). The rates of antibiotic resistance in S.aureus strains were as follows; gentamicin 89%, tetracycline 57%, rifampin and ciprofloxacin 46%, and macrolides (erythromycin and clindamycin) 32%. No resistance was detected against trimethoprim-sulfamethoxazole, vancomycin and teicoplanin. On the other hand, presence of inducible macrolid-lincosamide-streptogramin B (iMLSB) resistance phenotype in 8 (44.5%) out of 18 smr positive strains compared to 2 (6.25%) out of 32 smr negative strains was statistically significant (p< 0.001). We concluded that smr genes were detected to be more prevalent than qacA/B genes in our clinical S.aureus isolates. smr genes were found only in MRSA strains whereas low number of qacA/B genes were found only in MSSA strains. Presence of smr genes concomitantly with iMLSB type resistance in MRSA strains was recorded to be interesting. We believe that data of this preliminary study about antiseptic and antibiotic cross resistance would be useful for the future related studies.

摘要

金黄色葡萄球菌是一种具有重大医学意义的微生物,可导致皮肤和软组织感染、菌血症及心内膜炎。金黄色葡萄球菌分离株对包括防腐剂和消毒剂在内的多种抗菌药物的耐药性日益增强。季铵化合物是在控制医院感染中发挥重要作用的消毒剂。赋予对季铵化合物耐药性的基因广泛分布于从世界某些地区分离出的临床葡萄球菌中。在本研究中,我们旨在研究临床金黄色葡萄球菌菌株中防腐剂耐药基因(qac A/B、smr)的流行情况及抗生素耐药性,并检测防腐剂耐药性与抗生素耐药性之间可能存在的关系。为此,采用多重聚合酶链反应检测了50株甲氧西林敏感金黄色葡萄球菌(MSSA)和50株甲氧西林耐药金黄色葡萄球菌(MRSA)临床分离株(78株脓肿标本、13株血液标本、3株痰液标本、3株气管吸出物标本、2株鼻拭子标本、1株尿液标本)中qac A/B和smr基因的存在情况。根据临床实验室标准协会(CLSI)的建议,采用纸片扩散法测定金黄色葡萄球菌菌株对不同抗生素(头孢西丁、红霉素、克林霉素、利福平、四环素、环丙沙星、庆大霉素、甲氧苄啶-磺胺甲恶唑、万古霉素、替考拉宁)的敏感性。在50株MRSA中有18株(36%)检测到smr基因,在50株MSSA中有2株(4%)检测到qacA/B基因。与MSSA菌株相比,仅在MRSA菌株中发现smr基因具有统计学意义(p<0.001)。金黄色葡萄球菌菌株的抗生素耐药率如下:庆大霉素89%、四环素57%、利福平和环丙沙星46%、大环内酯类(红霉素和克林霉素)32%。未检测到对甲氧苄啶-磺胺甲恶唑、万古霉素和替考拉宁的耐药性。另一方面,18株smr阳性菌株中有8株(44.5%)存在诱导型大环内酯-林可酰胺-链阳菌素B(iMLSB)耐药表型,而32株smr阴性菌株中有2株(6.25%)存在该表型,差异具有统计学意义(p<0.001)。我们得出结论,在我们的临床金黄色葡萄球菌分离株中,检测到smr基因比qacA/B基因更普遍。smr基因仅在MRSA菌株中发现,而qacA/B基因仅在少数MSSA菌株中发现。MRSA菌株中smr基因与iMLSB型耐药性同时存在的情况值得关注。我们认为,这项关于防腐剂和抗生素交叉耐药性的初步研究数据将对未来相关研究有用。

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