人工关节假体感染中表皮葡萄球菌的毒力及耐药基因研究  

Research on virulence and drug resistance gene of Staphylococcus epidermidis in periprosthetic joint infection

作　　者：郭宇[1] 魏莹 刘颖[1] 梁玉龙 程翔 GUO Yu;WEI Ying;LIU Ying(Department of Laboratory,Beijing Jishuitan Hospital,Beijing 100035,China)

机构地区：[1]北京积水潭医院检验科,北京100035

出　　处：《临床和实验医学杂志》2021年第13期1433-1437,共5页Journal of Clinical and Experimental Medicine

基　　金：北京积水潭医院院级科研基金项目(编号:QN-201905)。

摘　　要：目的检测人工关节假体感染中的表皮葡萄球菌毒力和耐药基因的携带情况,分析其与耐药性的关系,为临床抗感染治疗提供实验依据。方法回顾性收集2017年1月至2020年12月间北京积水潭医院收治的关节假体周围感染患者的关节液标本,≥2份标本细菌培养阳性且剔除重复病例后,共82株表皮葡萄球菌纳入本次研究。聚合酶链式反应(PCR)扩增后经凝胶电泳检测生物膜相关基因icaA/bhp/IS256以及耐药基因mecA;测定其对11种临床常用抗生素的最小抑菌浓度并计算耐药率;采用Wilcoxon秩和检验对携带不同基因的菌株的耐药率进行比较。结果82株表皮葡萄球菌中,icaA检出率为56.0%(46/82),bhp检出率为45.1%(37/82),IS256检出率为100%(82/82),mecA检出率为68.9%(68/82);82株表皮葡萄球菌对青霉素耐药率为90.5%;对红霉素、复方新诺明和克林霉素耐药率分别为56.1%、54.7%和40.1%;对庆大霉素和环丙沙星耐药率分别为35.4%和33.0%;未检出万古霉素、替考拉宁和利奈唑胺耐药株;mecA阳性株即MRSE,比mecA阴性株即MSSE,表现出对红霉素、克林霉素和庆大霉素更强的耐药性,差异均有统计学意义(P<0.05);bhp阳性株对利福平耐药性高于bhp阴性株,差异有统计学意义(P<0.05)。结论关节假体感染中的表皮葡萄球菌中以MRSE为主,未发现万古霉素、替考拉宁、利奈唑胺耐药株;生物膜相关基因icaA、bhp、IS256检出率较高。Objective To detect the virulence and drug resistance genes of Staphylococcus epidermidis in periprosthetic joint infection,and analyze the relationship between these genes and drug resistance to provide more experimental basis for clinical anti-infective treatment.Methods The synovial fluid specimens of patients with periprosthetic infections admitted to Beijing Jishuitan Hospital from January 2017 to December 2020 were collected retrospectively.After≥2 specimens were positive for bacterial culture and repeated cases were excluded,a total of 82 strains of Staphylococcus epidermidis were included this research.Adhesion or Biofilm-related genes,including icaA/bhp/IS256 and drug resistance gene mecA were detected by polymerase chain reaction(PCR).Antibiotic resistance and minimum inhibitory concentration of various antibiotics were analyzed.Wilcoxon rank sum test was used to compare the drug resistance rate of strains with different genes.Results The positive rate of icaA in 82 strains of S.epidermidis was 56.0%(46/82),the positive rate of bhp and IS256 was 45.1%and 100%,respectively.Meanwhile,68.9%of strains were detected mecA.The resistance rate of S.epidermidis to penicillin,erythromycin,sulfamethoxazole,and clindamycin was 90.5%,56.1%,54.7%,and 40.1%,respectively.35.4%and 33.0%of strains were resistant to gentamicin and ciprofloxacin.All strains were sensitive to vancomycin,teicoplanin,and linezolid.mecA positive strains were more resistant to erythromycin,clindamycin,and gentamicin than mecA negative strains.The resistance of bhp positive strains to rifampicin was significantly higher than that of bhp negative strains.Conclusion MRSE was the primary type of S.epidermidis in periprosthetic joint infection,and all strains were sensitive to vancomycin and linezolid and showed a high incidence of Biofilm-related genes such as icaA,bhp,and IS256.

关 键 词：关节假体感染 表皮葡萄球菌 icaA BHP IS256 MECA 耐药性 

分 类 号：R446.5[医药卫生—诊断学] R687.4[医药卫生—临床医学]