抗甲氧苯青黴素金黃色葡萄球菌分子流行病學研究

Molecular Epidemiology of Methicillin-Resistant Staphylococcus aureus

楊喜蘭(Yang Hsilan)

指導教授 ： 廖明輝

國立屏東科技大學/農學院/獸醫學系所/碩士(2011年)

https://doi.org/10.6346/NPUST.2011.00072

摘要

金黃色葡萄球菌是引起院內或社區感染的主要病原菌。本菌常引起皮膚、軟組織和肺臟的感染後造成嚴重的壞死。在全世界抗藥性菌株的增加已經成為公共衛生問題，抗甲氧苯青黴素金黃色葡萄球菌(Methicillin-resistant Stapyhlococcus aureus, MRSA)的控制仍然是大部份醫院首要的感染控制計劃的重點。本研究的目的是為了了解及分析MRSA之分子流行病學及抗生素敏感性之間相關性。菌株的分離從2009年1月至12月，共收集439株從屏東某教學醫院臨床所分離的金黃色葡萄球菌，對其中的抗甲氧苯青黴素菌株(MRSA)進行研究分析。MRSA 佔全部分離株的47.8%( n=210)，另外，甲氧苯青黴素敏感性金黃色葡萄球菌(Methicillin-susceptible Stapyhlococcus aureus, MSSA)佔52.2%(n=229)。檢體來源包括膿液，呼吸道，血液，尿液及其他。藥物敏感性試驗所使用的是肉湯微量稀釋方法。利用脈衝式膠體電泳(Pulsed-field gel electrophoresis, PFGE)做為MRSA的分子分型，以酵素SmaI消化處理DNA。MRSA對抗生素penicillin,ampicillin/sulbactam, clindamycin及erythromycin抗藥性比率是較高的，結果為超過80%，所有的分離菌株對vancomycin, linezolid及 teicoplanin是呈敏感性。MRSA的藥物敏感性試驗結果有10種不同類型的抗生素抗藥性圖譜，其中有5種佔所有MRSA菌株的95.7%(n=201)。PFGE的分析結果獲得148種不同的圖譜，可分為20種型別，將其命名為從A到T。其中型別A, E, G, J, N, O, P或T是佔所有MRSA菌株的76.2%(n=160)。這些結果有助於了解從病人所分離的MRSA菌株，其分子流行病學及抗生素抗藥性圖譜的特性，將研究所獲得之結果做為MRSA感染的預防及控制。

關鍵字

抗甲氧苯青黴素金黃色葡萄球 ； 分子流行病學 ； 脈衝式膠體電泳

並列摘要

Staphylococcus aureus is the most common pathogen that causes nosocomial or community-acquired infections. S. aureus causes severe necrotizing infections of the skin, soft tissues, and lungs. Antimicrobial resistance is an increasing public health problem worldwide. Controlling methicillin-resistant Stapyhlococcus aureus (MRSA) remains a primary focus of most hospital infection control programs. The purpose of this study was to understand and analyse the relationship between molecular epidemiology and antibiotic susceptibility of MRSA. From January to December 2009, methillin resistance was investigated among a total of 439 S. aureus isolated from teaching hospital in Pingtung. MRSA isolates accounted for 47.8%(n=210) of all isolates, methicillin- susceptible Stapyhlococcus aureus (MSSA) isolates accounted for the other 52.2%(n=229). Specimen source included pus, respiratory tract, blood, urine, and others. Susceptibility testing was performed by a broth microdilution method. Pulsed-field gel electrophoresis (PFGE) was used for molecular typing of MRSA isolates, DNA was digested with the enzyme SmaI. The MRSA resistance rates to penicillin, ampicillin/sulbactam, clindamycin, and erythromycin were higher than 80%, that all were susceptible to vancomycin, linezolid, and teicoplanin. Ten antimicrobial resistance patterns were found, of which five accounted for 95.7%(n=201) of the MRSA isolates. The PFGE revealed 148 different patterns, were grouped into 20 types, designated A through T. Of all the MRSA isolates, 76.2%(n=160) were assigned to type A, E, G, J, N, O, P or T. These results could be helpful for understanding molecular epidemiology and antimicrobial resistance patterns characteristics of MRSA isolates from patients. The results obtained from this study can provide important information on the prevention and control of MRSA infections.

並列關鍵字

methicillin-resistant Stapyhlococcus aureus ； molecular epidemiology ； pulsed-field gel electrophoresis

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