骨科患者术后皮肤及软组织感染分离金黄色葡萄球菌耐药基因  

Characteristics of drug resistance and distribution of drug resistance genes of Staphylococcus aureus isolated from postoperative skin and soft tissue infections in orthopedic patients

作　　者：蒋丽迁 韩松花 李雪飞 黎高明 高岑钰 JIANG Li-qian;HAN Song-hua;LI Xue-fei;LI Gao-ming;GAO Ceng-yu(Quzhou City Hospital of Traditional Chinese Medicine,Quzhou,Zhejiang 324000,China)

机构地区：[1]衢州市中医医院院感处,浙江衢州324000 [2]衢州市中医医院护理部,浙江衢州324000 [3]衢州市中医医院骨科,浙江衢州324000 [4]衢州市中医医院检验科,浙江衢州324000

出　　处：《中华医院感染学杂志》2021年第20期3153-3156,共4页Chinese Journal of Nosocomiology

基　　金：浙江省科研基金资助项目(2018GH101)。

摘　　要：目的探讨骨科术后皮肤及软组织感染分离金黄色葡萄球菌耐药特点及耐药基因分布。方法 131株金黄色葡萄球菌分离自2015年3月-2020年3月衢州市中医医院发生皮肤及软组织感染患者,对病原进行培养并调查耐药性;采用聚合酶链式扩增反应检测分离出的金黄色葡萄球菌耐药基因携带情况,分析骨科术后耐甲氧西林金黄色葡萄球菌(MRSA)皮肤及软组织感染的危险因素。结果检出金黄色葡萄球菌、甲氧西林敏感金黄色葡萄球菌(MSSA)、MRSA对青霉素耐药率均为100%,对万古霉素、利奈唑胺和替拉考宁耐药率均为0.00%;金黄色葡萄球菌mecA基因检出率为96.95%,MRSA与MSSA各耐药基因检出率比较差异无统计学意义;骨科术后发生MRSA皮肤及软组织感染患者与年龄、术后住院时间、合并糖尿病、术前营养状态及激素类药物有关(P<0.05);多元Logistic回归分析结果显示,年龄、术后住院时间、合并糖尿病、术前营养状态和激素类药物应用是骨科患者术后MRSA皮肤及软组织感染的危险因素(P<0.05)。结论本地区骨科术后MRSA分离率较高,应根据耐药性结果选择经验性抗菌药物,同时针对临床危险因素对MRSA皮肤及软组织感染进行预防。OBJECTIVE To investigate the characteristics of drug resistance and the distribution of drug resistance genes of Staphylococcus aureus isolated from skin and soft tissue infections after orthopedic surgery.METHODS Totally 131 strains of S.aureus were isolated from patients with skin and soft tissue infections in Quzhou Hospital of Traditional Chinese Medicine from Mar.2015 to Mar.2020.The pathogens were cultured and drug resistance was investigated.Polymerase chain reaction(PCR) was used to detect the carrying status of drug-resistant genes in S.aureus,and the risk factors of skin and soft tissue infection caused by methicillin-resistant S.aureus(MRSA) after orthopedic surgery were analyzed.RESULTS The resistance rates of S.aureus,methicillin-sensitive S.aureus(MSSA) and MRSA to penicillin were all 100 %,and the resistance rates to vancomycin,linezolid and teicoplanin were all 0.00 %.The detection rate of mecA gene in S.aureus was 96.95 %,and there was no significant difference between MRSA and MSSA.Patients with MRSA skin and soft tissue infections after orthopedic surgery were related to age,postoperative hospital stay,diabetes mellitus,preoperative nutritional status and hormone drugs(P<0.05).Multivariate logistic regression analysis showed that age,postoperative hospital stay,diabetes mellitus and preoperative nutritional status hormone drugs were the risk factors for MRSA skin and soft tissue infections after orthopedic surgery(P<0.05).CONCLUSION The isolation rate of MRSA after orthopedic surgery in this area was relatively high.Empirical antibacterial drugs should be selected based on the results of drug resistance,and the MRSA skin and soft tissue infection should be prevented based on clinical risk factors.

关 键 词：骨科 皮肤及软组织感染 金黄色葡萄球菌 耐药特点 耐药基因 

分 类 号：R378[医药卫生—病原生物学]