目的 研究比較異質(zhì)性萬古霉素中介金黃色葡萄球菌（hVISA）的幾種篩查方法，制定出適合的hVISA的篩查方法。方法 收集2018年1月—2019年12月江南大學(xué)附屬醫(yī)院臨床標(biāo)本中分離出的耐甲氧西林金黃色葡萄球菌株（MRSA），采用宏量E-test法（MET法）、BHIV3V、BHIV6V及MHA5T法篩查hVISA，最后用菌群曲線分析法（PAP-AUC）確認(rèn)，比對(duì)4種篩查方法的敏感性及特異性。結(jié)果 538株金黃色葡萄球菌經(jīng)頭孢西丁紙片法篩查出MRSA 266例，MRSA陽性率為49.4%；266株MRSA中經(jīng)PAP-AUC確認(rèn)hVISA菌株為17株，檢出率為6.4%；MET法篩選出hVISA 21例，其中確認(rèn)hVISA菌株為14例，敏感性為82.3%，特異性為97.1%。BHIV6V法篩查出hVISA 2株，確認(rèn)均為hVISA，敏感性為11.8%，特異性100%。BHIV3V法篩查出hVISA 44株，確認(rèn)為hVISA菌株為11株，敏感性為64.7%，特異性86.7%。MHA5T法篩查出hVISA 56株，確認(rèn)hVISA為9株，敏感性為52.9%，特異性81.1%。MRSA除對(duì)利奈唑胺及萬古霉素敏感外，對(duì)多種抗菌藥物表現(xiàn)為多重耐藥。結(jié)論 本院MRSA檢出率為49.4%，高于全國(guó)耐藥監(jiān)測(cè)網(wǎng)統(tǒng)計(jì)數(shù)據(jù)。hVISA的檢出率為6.08%，MET法在敏感性及特異性方面優(yōu)于其他3種方法，此方法較適合在本院開展hVISA的篩查。檢出的MRSA及hVISA除對(duì)利奈唑胺及萬古霉素敏感外，表現(xiàn)為多種抗菌藥物的耐藥性，尤其是hVISA具有更高的耐藥性，臨床治療時(shí)應(yīng)按照藥敏結(jié)果選取治療藥物，切勿隨意進(jìn)行經(jīng)驗(yàn)性用藥。

Objective To study several different screening methods of hVISA by contrast method, so as to find the hVISA screening method suitable for Affiliated Hospital of Jiangnan University. Methods Strains of Staphylococcus aureus isolated from clinical specimens in Affiliated Hospital of Jiangnan University from January 2018 to December 2019 were collected and screened by cefoxetine sensitive tissue method. In vitro antimicrobial susceptibility test was performed on clinically isolated MRSA by broth dilution method, and WHONET5.6 was used for analysis. hVISA was screened by MET、BHIV3V、BHIV6 and MHA5T, the sensitivity and specificity of the four methods were confirmed by PAP-AUC. Results 266 cases of MRSA were detected in 538 strains of Staphylococcus aureus by cefoxitin paper method, and the positive rate of MRSA was 49.4%. Among 266 strains of MRSA, 17strains of hVISA were confirmed by PAP-AUC, with a detection rate of 6.4%. 21 cases of hVISA were screened by macro E-test, among which 14 cases were confirmed as hVISA strain, with sensitivity of 82.3% and specificity of 97.1%.Two hVISA strains were screened by BHIV6V method and confirmed to be hVISA, with a sensitivity of 11.8% and specificity of 100%. 44 hVISA strains were screened by BHIV3V method, and 11 strains were confirmed as hVISA strains, with a sensitivity of 64.7% and specificity of 86.7%. 56 hVISA strains were screened by MHA5T method, and 9 hVISA strains were confirmed with sensitivity of 52.9% and specificity of 81.1%. In addition to linezolid and vancomycin, MRSA shows multiple resistance to various antimicrobial agents. Conclusion The MRSA detection rate in Affiliated Hospital of Jiangnan University was 49.4%, higher than the national drug resistance monitoring network statistics. The detection rate of hVISA is 6.08%, and the macro E-test method is better than the other three methods in terms of sensitivity and specificity, which is more suitable for hVISA screening in Affiliated Hospital of Jiangnan University. In addition to linezolid and vancomycin, the detected MRSA and hVISA showed resistance to a variety of antimicrobial drugs, especially hVISA had higher resistance. In clinical treatment, treatment drugs should be selected according to drug sensitivity results, and do not use empirical drugs randomly.

R978

無錫市衛(wèi)計(jì)委科研面上項(xiàng)目（MS201813）