【摘要】 目的 分析上海浦东地区医院与社区获得性耐甲氧西林金黄色葡萄球菌(MRSA)的药敏表型、分子特征及遗传进化关系，以期为精准防控提供数据支持。方法 2024年6—12月共收集8所医院101株MRSA菌株，分为医院获得性MRSA(HA-MRSA)和社区获得性MRSA(CA-MRSA),比较两组MRSA耐药率、耐药基因及毒力基因携带情况，同时进行多位点序列分型(MLST)及系统发育分析。结果 101株MRSA中，CA-MRSA 63株，HA-MRSA 38株，主要标本类型均为痰液。HA-MRSA对左氧氟沙星和四环素耐药率均高于CA-MRSA(均P<0.05),未检出对呋喃妥因、万古霉素、利福平耐药菌株。101株MRSA共携带13类45种耐药基因，HA-MRSA中mecI、mecR1、ant(4′)-Ib、ermA、tetM的携带率均高于CA-MRSA(均P<0.05),两组MRSA消毒剂抗性基因qacA携带率均较高(分别为26.32%、15.87%)。101株MRSA携带sea、seb等4种肠毒素基因；两组均以seb基因携带率最高；杀白细胞素PVL由lukS-PV和lukF-PV基因共同编码，HA-MRSA中lukF-PV携带率高于CA-MRSA(89.47%VS 65.08%,P<0.05)。3株ST22型MRSA同时携带lukS-PV和lukF-PV基因，且其中1株同时携带tsst-1基因。101株MRSA共检出14种ST型，以ST764(53.47%)、ST398(13.86%)和ST59(7.92%)为主，且膦酸类、莫匹罗星耐药基因及消毒剂抗性基因仅存在于ST764中。基于SNP的系统发育树显示，HA-MRSA与CA-MRSA交错分布。结论 HA-MRSA对多种抗菌药物耐药率、耐药及毒力基因携带率高于CA-MRSA,耐药形势严峻，ST型别丰富，需构建医院-社区一体化监测与干预网络，实施协同综合防控。更多还原

【Abstract】 Objective To analyze antimicrobial susceptibility phenotypes, molecular characteristics, and genetic evolution of healthcare-associated(HA) and community-associated(CA) methicillin-resistant Staphylococcus aureus(MRSA) strains in Pudong area, Shanghai, and provide data support for precise prevention and control. Methods From June to December 2024, a total of 101 MRSA strains were collected from 8 hospitals and divided into HA-MRSA and CA-MRSA groups. Antimicrobial resistance rate, as well as resistance and virulence genes of two groups of MRSA were compared. Multilocus sequence typing(MLST) and phylogenetic analysis were performed. Results Among the 101 MRSA strains, 63 were CA-MRSA and 38 were HA-MRSA, with sputum being the main specimen type. The resistance rates of HA-MRSA to levofloxacin and tetracycline were both higher than CA-MRSA(both P<0.05). No strains resistant to furantoin, vancomycin, and rifampicin were detected. 101 MRSA strains carried 45 resistance genes of 13 classes, carrying rates of mecI, mecR1, ant(4′)-Ib, ermA, and tetM in HA-MRSA were all higher than in CA-MRSA(all P<0.05). The carrying rates of the disinfectant-resistant gene qacA in two groups of MRSA were high(26.32% and 15.87%, respectively). 101 MRSA strains carried 4 enterotoxin genes, including sea and seb; the highest carriage rate in both groups was that of seb gene; Panton-Valentine leukocidin(PVL) was co-encoded by the lukS-PV and lukF-PV genes, and the carrying rate of lukF-PV in HA-MRSA was higher than in CA-MRSA(89.47% vs 65.08%, P<0.05). Three ST22 MRSA strains carried both lukS-PV and lukF-PV genes, and one of them also carried tsst-1 gene. A total of 14 STs were detected from 101 MRSA strains, with ST764(53.47%), ST398(13.86%), and ST59(7.92%) being the main types. Antimicrobial resistance genes for phosphonic acid and mupirocin, as well as disinfectant-resistant genes only presented in ST764. Single nucleotide polymorphism(SNP)-based phylogenetic tree showed that HA-MRSA and CA-MRSA distributed alternately. Conclusion HA-MRSA possesses higher resistance rates and higher carriage rates of resistance and virulence genes than CA-MRSA, indicating a more severe resistance situation and abundant STs. It is necessary to establish a hospital-community integrated monitoring and intervention network and implement coordinated comprehensive prevention and control.更多还原