摘要
目的:了解皮肤软组织感染(SSTIs)社区获得性耐甲氧西林金黄色葡萄球菌(CA-MRSA)的分子特征、耐药率及毒力基因携带情况,为临床抗生素使用及感染防控提供流行病学依据。方法:回顾分析衢州市人民医院2014至2018年皮肤软组织感染金黄色葡萄球菌,从中筛选出CA-MRSA菌株共72株,采用多位点序列分型(MLST)方法进行分子分型,采用纸片扩散法(K-B法)和微量肉汤稀释法进行药敏试验,使用聚合酶链式反应(PCR)方法对所收集菌株的7种毒力基因包括纤连蛋白结合蛋白基因(fnbA,fnbB)、溶血素基因(hla,hlb)、肠毒素基因(sec,seh)、杀白细胞素基因(PVL)进行分析,采用χ^2检验或Fisher精确检验对ST59组和非ST59组之间耐药率和毒力基因携带率之间的差异进行统计分析。结果:衢州地区SSTIs CA-MRSA以ST59型(55.56%,40/72)为主要流行克隆株。所有分离株对红霉素(90.28%,65/72)、克林霉素(68.06%,49/72)、四环素(41.67%,30/72)具有较高的耐药率,对万古霉素、呋喃妥因、达托霉素及利奈唑胺全部敏感,序列型59(ST59)型对克林霉素的耐药率为(85.00%,34/40),ST59对克林霉素的耐药率明显高于其他克隆型(χ^2=11.886,P<0.01)。其余抗生素的耐药率在两组之间没有显著性差异。72株皮肤软组织感染CA-MRSA毒力基因的携带率分别为hla(97.22%,70/72)、hlb(33.33%,24/72)、fnbA(50.00%,36/72)、fnbB(48.61%,35/72)、PVL(63.89%,46/72)、sec(4.17%,3/72)、seh(4.17%,3/72),PVL基因在ST59中的携带率为(77.50%,31/40),ST59 PVL携带率显著高于在其他非ST59中的携带率(χ^2=7.227,P<0.01)。结论:衢州地区SSTIs CA-MRSA的主要克隆为ST59型,与全国其他地区一致,ST59型分离株PVL基因的携带率明显高于其他分离株。SSTIs CA-MRSA对红霉素及克林霉素具有较高的耐药率,治疗中不宜作为经验性用药的首选。
Objective To investigate the molecular characteristics,drug resistance rate and virulence genes harboring status of community-acquired methicillin-resistant Staphylococcus aureus(CA-MRSA)associated with skin and soft tissue infections(SSTIs),and provide epidemiological basis for clinical antibiotic usage and infection prevention and control.Methods The Staphylococcus aureus associated with SSTIs in Quzhou People′s Hospital from 2014 to 2018 were retrospectively analyzed.A total of 72 CA-MRSA isolates were screened,and molecular typing was performed by multilocus sequence typing(MLST).K-B method and micro broth dilution method were used to analyze the antibiotic susceptibilities of those strains.The virulence genes screened including fibronectin binding protein genes(fnbA,fnbB),hemolysin genes(hla,hlb),enterotoxin genes(sec,seh)and leukocidin gene(PVL)were detected by polymerase chain reaction(PCR).Statistical analysis of differences between drug resistance rates and virulence genes carrier rates between ST59 and non-ST59 groups used were Chi-square test or Fisher exact test.Results ST59 type was the main epidemic clone in skin and soft tissue infection CA-MRSA in Quzhou area with account for 55.56%(40/72).All isolates had higher resistance rates to erythromycin(90.28%,65/72),clindamycin(68.06%,49/72)and tetracycline(41.67%,30/72).The nitrofurantoin,daptomycin and linezolid were all sensitive.The resistance rate to clindamycin of sequence type 59(ST59)was(85.00%,34/40).The resistance rate of ST59 to clindamycin was significantly higher than that of other clone types(χ^2=11.886,P<0.01).There was no significant difference in the resistance rates of other antibiotics.All 72 isolates exhibited carriage of virulence genes as follows,hla(97.22%,70/72),hlb(33.33%,24/72),fnbA(50.00%,36/72),fnbB(48.61%,35/72),PVL(63.89%,46/72),sec(4.17%,3/72),seh(4.17%,3/72).The carrier rate of PVL gene in ST59 type was(77.50%,31/40).ST59 showed higher rates of PVL genes compared with other clone types(χ^2=7.227,P<0.01).Conclusions The main clone of CA-MRSA associated with SSTIs in Quzhou was ST59,which was similar to other parts of the Country.The carrying rate of PVL gene of ST59 isolate was significantly higher than that of other isolates.CA-MRSA associated with SSTIs has a high resistance rate to erythromycin and clindamycin,which should not be used as the first choice in treatment.
作者
胡梅梅
陆军
程颖
白永凤
张莉
张峰
祝进
Hu Meimei;Lu Jun;Cheng Ying;Bai Yongfeng;Zhang Li;Zhang Feng;Zhu Jin(The 3rd Department of Clinical Medicine,Zhejiang University School of Medicine,Grade 2017,Hangzhou 310058,China;Department of Clinical Laboratory,Quzhou People′s Hospital,Quzhou 324000,China;the 3rd Department of Clinical Medicine,Zhejiang University School of Medicine,Grade 2016,Hangzhou 310058,China)
出处
《中华检验医学杂志》
CAS
CSCD
北大核心
2020年第4期432-437,共6页
Chinese Journal of Laboratory Medicine
基金
浙江省医药卫生科研基金(2017KY698)
衢州市科技局指导性项目(20172029)。
