2016-2017 年科威特医院耐甲氧西林金黄色葡萄球菌克隆的抗生素耐药性和分型。
Antibiotic resistance and typing of the methicillin-resistant Staphylococcus aureus clones in Kuwait hospitals, 2016-2017.
机构信息
Department of Microbiology, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait.
出版信息
BMC Microbiol. 2020 Oct 16;20(1):314. doi: 10.1186/s12866-020-02009-w.
BACKGROUND
Methicillin-resistant Staphylococcus aureus (MRSA) belong to diverse genetic backgrounds that differ in antibiotic resistance. Knowledge of the local clonal composition of MRSA strains is important for patients' management and for designing effective control and eradication methods. The aim of this study was to compare the antibiotic resistance patterns and genotypic characteristics of MRSA isolates obtained in public hospitals in Kuwait in 2016 and 2017 for changes in their resistance patterns and clonal composition.
METHODS
A total of 4726 MRSA isolates obtained in 2016-2017 from clinical specimens in Kuwait public hospitals were characterized using antibiogram, SCCmec typing, spa typing and DNA microarray.
RESULTS
The isolates expressed resistance to fusidic acid (52.9%), kanamycin (41.6%), gentamicin (32.5%) and erythromycin (36.2%). The prevalence of high-level mupirocin resistance decreased from 3.7% in 2016 to 2.4% in 2017, while the proportion of resistance to other antibiotics remained relatively stable. A total of 382 spa types were detected with eight spa types, t688 (N = 547), t304 (N = 428), t860 (N = 394), t127 (N = 306), t044 (N = 230), t311 (N = 243), t223 (N = 184) and t002 (N = 181) constituting 53.1% of the MRSA isolates in 2016-2017. Of the 3004 MRSA isolates obtained in 2016 (N = 1327) and 2017 (N = 1677) selected for DNA microarray analysis, 26 clonal complexes (CCs) were identified. Most of the isolates belonged to CC1 (N = 248), CC5 (N = 833), CC6 (N = 241), CC8 (N = 292), CC22 (N = 421), CC30 (N = 177), CC80 (N = 177) and CC97 (N = 171). The prevalence of CC5 isolates has significantly (p ≤ 0.05) increased from 294 isolates in 2016 to 539 isolates in 2017. Although CC22 increased from 196 isolates in 2016 to 225 isolates in 2017, CC1 increased from 112 isolates in 2016 to 136 isolates in 2017, CC6 increased from 103 isolates in 2016 to 138 isolates in 2017, these changes were not significant (p ≥ 0.05).
CONCLUSION
These results revealed the diversity in the genetic backgrounds of MRSA isolates and the stable maintenance of the dominant MRSA clones in Kuwait hospitals in 2016 and 2017 suggesting an on-going transmission of these clones. Novel and creative infection prevention and control measures are required to curtail further transmission.
背景
耐甲氧西林金黄色葡萄球菌 (MRSA) 属于不同的遗传背景，在抗生素耐药性方面存在差异。了解 MRSA 菌株在当地的克隆组成对于患者的管理以及设计有效的控制和根除方法非常重要。本研究旨在比较 2016 年和 2017 年科威特公立医院分离的 MRSA 菌株的抗生素耐药模式和基因特征，以了解其耐药模式和克隆组成的变化。
方法
从 2016 年至 2017 年期间科威特公立医院的临床标本中分离出 4726 株 MRSA 菌株，采用药敏试验、SCCmec 分型、spa 分型和 DNA 微阵列进行鉴定。
结果
这些分离株对夫西地酸（52.9%）、卡那霉素（41.6%）、庆大霉素（32.5%）和红霉素（36.2%）表现出耐药性。高水平米诺环素耐药的流行率从 2016 年的 3.7%下降到 2017 年的 2.4%，而对其他抗生素的耐药率保持相对稳定。共检测到 382 种 spa 型，其中 8 种 spa 型，t688（N=547）、t304（N=428）、t860（N=394）、t127（N=306）、t044（N=230）、t311（N=243）、t223（N=184）和 t002（N=181）构成 2016-2017 年 MRSA 分离株的 53.1%。在 2016 年（N=1327）和 2017 年（N=1677）获得的 3004 株 MRSA 分离株中选择进行 DNA 微阵列分析，共鉴定出 26 个克隆复合体（CC）。大多数分离株属于 CC1（N=248）、CC5（N=833）、CC6（N=241）、CC8（N=292）、CC22（N=421）、CC30（N=177）、CC80（N=177）和 CC97（N=171）。CC5 分离株的流行率从 2016 年的 294 株显著增加到 2017 年的 539 株（p≤0.05）。尽管 CC22 从 2016 年的 196 株增加到 2017 年的 225 株，但 CC1 从 2016 年的 112 株增加到 2017 年的 136 株，CC6 从 2016 年的 103 株增加到 2017 年的 138 株，这些变化没有统计学意义（p≥0.05）。
结论
这些结果表明，MRSA 分离株的遗传背景存在多样性，2016 年和 2017 年科威特医院中主要的 MRSA 克隆保持稳定，表明这些克隆仍在持续传播。需要采取新颖和创造性的感染预防和控制措施来遏制进一步的传播。
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