埃及三家三级医院耐甲氧西林金黄色葡萄球菌的多重耐药率很高。

High Prevalence of Multi-drug Resistant Methicillin-Resistant Staphylococcus aureus in Tertiary Egyptian Hospitals.

机构信息

Microbiology and Immunology Department, Faculty of Pharmacy (Boys), Al-Azhar University, Nasr City, Cairo, Egypt.

出版信息

J Infect Dev Ctries. 2022 May 30;16(5):795-806. doi: 10.3855/jidc.15833.

DOI:10.3855/jidc.15833

PMID:35656950

Abstract

INTRODUCTION

Methicillin-resistant Staphylococcus aureus (MRSA) is an emerging cause of morbidity and mortality worldwide. This work aimed to study the occurrence of multidrug-resistant MRSA (MDR-MRSA) in tertiary Egyptian hospitals and determine the antimicrobial susceptibilities and the genetic relatedness of isolates for epidemiological assessment.

METHODOLOGY

A total of 170 S. aureus isolates were collected from two Egyptian tertiary hospitals in Cairo, between September 2017 and December 2018. MRSA isolates were identified using the conventional microbiological methods and confirmed by the PCR assays targeting nuc gene, a surrogate marker of S. aureus and the mecA gene for genotypic identification of methicillin resistance. Antimicrobial susceptibility was determined using the Kirby-Bauer disk diffusion method and the isolates were grouped into different antibiotypes based on their antibiograms. The genetic relatedness among MDR-MRSA isolates was determined by ERIC-PCR-based molecular typing.

RESULTS

High prevalence of MRSA isolates was identified (138/170, 81.2%) with 79% of isolates (109/138, 79%) being MDR-MRSA. MRSA isolates were resistant to diverse classes of antimicrobials including β-lactams, aminoglycosides and macrolides. Among MRSA isolates, the highest resistance rate was to each cefoxitin and penicillin (100%) and the highest susceptibility was to linezolid (92%). Based on the antibiograms of 109 MDR-MRSA isolates, 52 antibiotypes were determined, and 46 different ERIC fingerprints were identified among MDR-MRSA antibiotypes.

CONCLUSIONS

MRSA infections remain a noteworthy problem in Egyptian hospitals. MDR-MRSA isolates showed significant genetic diversity indicating the alarmingly high prevalence. Studies should be performed frequently, even in each healthcare setting, to determine the epidemiology of MRSA isolates and their antimicrobial susceptibility profiles for effective control measures of MRSA infections and better healthcare management.

摘要

简介

耐甲氧西林金黄色葡萄球菌（MRSA）是全球发病率和死亡率不断上升的原因。本研究旨在研究埃及三级医院中多重耐药性 MRSA（MDR-MRSA）的发生情况，并确定分离株的抗菌药敏性和遗传相关性，以便进行流行病学评估。

方法

2017 年 9 月至 2018 年 12 月，从开罗的两家埃及三级医院共采集了 170 株金黄色葡萄球菌分离株。使用常规微生物学方法鉴定 MRSA 分离株，并通过针对 nuc 基因（金黄色葡萄球菌的替代标志物）和 mecA 基因（用于确定耐甲氧西林的基因分型）的 PCR 检测来确认。使用 Kirby-Bauer 纸片扩散法测定抗菌药敏性，并根据药敏谱将分离株分为不同的抗生素型。通过 ERIC-PCR 基于分子分型确定 MDR-MRSA 分离株的遗传相关性。

结果

鉴定出高比例的 MRSA 分离株（138/170，81.2%），其中 79%（109/138，79%）为 MDR-MRSA。MRSA 分离株对包括β-内酰胺类、氨基糖苷类和大环内酯类在内的多种抗菌药物类别的耐药性很高。在 MRSA 分离株中，对头孢西丁和青霉素的耐药率最高（各为 100%），对利奈唑胺的敏感性最高（92%）。根据 109 株 MDR-MRSA 分离株的药敏谱，确定了 52 种抗生素型，并在 MDR-MRSA 抗生素型中鉴定出 46 种不同的 ERIC 指纹。