医院耐甲氧西林金黄色葡萄球菌感染的风险模型建立及耐药基因检测  

Establishment of risk prediction model for nosocomial methicillin-resistant Staphylococcus aureus infection and detection of drug resistance genes

作　　者：宋志伟[1] 蔡艳群[1] 郏伊范[1] 潘晓[1] SONG Zhiwei;CAI Yanqun;JIA Yifan;PAN Xiao(Department of Clinical Laboratory,Taizhou Municipal Hospital,Taizhou 318000,China)

机构地区：[1]台州市立医院检验科,318000

出　　处：《浙江医学》2022年第6期598-602,共5页Zhejiang Medical Journal

基　　金：台州市科技计划项目(1902ky47)。

摘　　要：目的建立医院耐甲氧西林金黄色葡萄球菌(MRSA)感染的风险模型,并检测耐药基因。方法收集2020年6月至2021年6月台州市立医院金黄色葡萄球菌(SA)感染患者的189份临床标本中分离出的189株SA,其中MRSA 62株,甲氧西林敏感金黄色葡萄球菌(MSSA)127株。采用logistic回归模型分析医院MRSA感染的独立危险因素,建立风险模型,并采用PCR法检测耐药基因。结果年龄、抗生素使用时间、抗生素使用种类、合并心脑血管疾病、合并慢性阻塞性肺疾病、留置胃管、留置尿管、留置引流管、气管切开/插管、机械通气均与MRSA感染有关(均P<0.05)。合并慢性阻塞性肺疾病(X8)、抗生素使用时间(X12)、抗生素使用种类(X13)、留置胃管(X14)、留置尿管(X15)、留置引流管(X16)、气管切开/插管(X17)、机械通气(X19)是MRSA感染的独立危险因素(均P<0.05);构建logistic回归方程:logit(P)=-23.006+1.057×X8+1.116×X12+1.445×X13+1.143×X14+1.226×X15+1.155×X16+1.322×X17+1.399×X19,拟合度较好。PCR检测结果显示,MRSA菌株中四环类(tetM)、氨基糖苷类aac(6')/aph(2")、氨基糖苷类aph(3')-Ⅲ表达高于MSSA菌株(均P<0.05),均未检出氨基糖苷类ant(4',4")。结论抗生素使用种类及使用时间、侵入性操作是医院MRSA感染的独立危险因素,且MRSA耐药更严重。Objective To establish a risk prediction model for nosocomial methicillin-resistant Staphylococcus aureus(MRSA)infection and to detect drug resistance genes.Methods A total of 189 SA strains were isolated from clinical specimens of patients admitted in Taizhou Municipal Hospital of Zhejiang Province from June 2020 to June 2021,including 62 MRSA strains and127 methicillin-sensitive Staphylococcus aureus(MSSA)strains.Logistic regression model was used to analyze the risk factors of nosocomial MRSA infection,and a risk prediction model was established.The drug resistance genes were detected with polymerase chain reaction(PCR)method.Results Age,duration of antibiotic use,type of antibiotics,comorbid cardioerebrovascular diseases and chronic obstructive pulmonary disease,indwelling gastric tube,urinary catheter and drainage tube,tracheotomy/intubation,mechanical ventilation were related to MRSA infection(P<0.05).Comorbid chronic obstructive pulmonary disease,duration of antibiotic use,type of antibiotics used,indwelling gastric tube,urinary tube and drainage tube,tracheotomy/intubation,and mechanical ventilation were independent risk factors for MRSA infection(P<0.05).Logistic regression equation was constructed:logit(P)=-23.006+1.057×X8+1.116×X12+1.445×X13+1.143×X14+1.226×X15+1.155×X16+1.322×X17+1.399×X19,and it had good fitting effect.PCR detection results showed that the expression of tetracyclic(tetM),aminoglycoside aac(6')/aph(2"),and aminoglycoside aph(3')-Ⅲgenes in MRSA strains were higher than that in MSSA strains(P<0.05).No aminoglycoside ant(4',4")gene was detected.Conclusion The type and duration of antibiotic use,and invasive procedures are independent risk factors for nosocomial MRSA infection.

关 键 词：医院感染 耐甲氧西林金黄色葡萄球菌 风险模型 耐药基因 

分 类 号：R446.5[医药卫生—诊断学]