目的 研究比较异质性万古霉素中介金黄色葡萄球菌（hVISA）的几种筛查方法，制定出适合的hVISA的筛查方法。方法 收集2018年1月—2019年12月江南大学附属医院临床标本中分离出的耐甲氧西林金黄色葡萄球菌株（MRSA），采用宏量E-test法（MET法）、BHIV3V、BHIV6V及MHA5T法筛查hVISA，最后用菌群曲线分析法（PAP-AUC）确认，比对4种筛查方法的敏感性及特异性。结果 538株金黄色葡萄球菌经头孢西丁纸片法筛查出MRSA 266例，MRSA阳性率为49.4%；266株MRSA中经PAP-AUC确认hVISA菌株为17株，检出率为6.4%；MET法筛选出hVISA 21例，其中确认hVISA菌株为14例，敏感性为82.3%，特异性为97.1%。BHIV6V法筛查出hVISA 2株，确认均为hVISA，敏感性为11.8%，特异性100%。BHIV3V法筛查出hVISA 44株，确认为hVISA菌株为11株，敏感性为64.7%，特异性86.7%。MHA5T法筛查出hVISA 56株，确认hVISA为9株，敏感性为52.9%，特异性81.1%。MRSA除对利奈唑胺及万古霉素敏感外，对多种抗菌药物表现为多重耐药。结论 本院MRSA检出率为49.4%，高于全国耐药监测网统计数据。hVISA的检出率为6.08%，MET法在敏感性及特异性方面优于其他3种方法，此方法较适合在本院开展hVISA的筛查。检出的MRSA及hVISA除对利奈唑胺及万古霉素敏感外，表现为多种抗菌药物的耐药性，尤其是hVISA具有更高的耐药性，临床治疗时应按照药敏结果选取治疗药物，切勿随意进行经验性用药。

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.

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无锡市卫计委科研面上项目（MS201813）