利奈唑胺耐药凝固酶阴性葡萄球菌耐药基因和菌种同源性及感染危险因素  

Resistance genes,strain homology and infection risk factors of Linezolid-resistant coagulase-negative Staphylococci

作　　者：王翠翠 范会 金炎 邵春红 王丽萍[3] WANG Cuicui;FAN Hui;JIN Yan;SHAO Chunhong;WANG Liping(Medical Department,Shandong Provincial Hospital Affiliated to Shandong First Medical University,Jinan 250021,China;不详)

机构地区：[1]山东第一医科大学附属省立医院医务部,济南250021 [2]山东第一医科大学附属省立医院临床医学检验部 [3]山东大学附属公共卫生临床中心汉光微生物实验室

出　　处：《山东医药》2022年第21期38-42,共5页Shandong Medical Journal

基　　金：济南市临床医学科技创新计划(202019050)。

摘　　要：目的观察利奈唑胺耐药凝固酶阴性葡萄球菌(LRCoNS)的耐药基因和菌种同源性,并分析发生LR⁃CoNS感染的危险因素。方法LRCoNS菌株45株,采用药敏试验观察耐药情况,采用PCR法观察耐药基因,采用脉冲场凝胶电泳实验观察菌种同源性。收集45例LRCoNS感染患者、90例利奈唑胺敏感凝固酶阴性葡萄球菌(LSCoNS)感染患者临床资料,采用多因素logistic回归分析法分析发生LRCoNS感染的危险因素。结果45株LR⁃CoNS对β内酰胺类抗菌药物、喹诺酮类抗菌药物及克林霉素的耐药率较高,对万古霉素、替加环素、利福平、四环素敏感率较高。45株LRCoNS中,21株携带cfr基因,4株携带optrA基因,33株在23S rRNA第V功能区不同等位基因发生突变,20株发生核糖体蛋白L3基因位点突变,4株发生核糖体蛋白L4基因位点突变,未检出多重耐药基因pox⁃tA。24株头状葡萄球菌相似度>90%,14株表皮葡萄球菌中13株相似度>90%,6株科氏葡萄球菌中4株相似度>90%。年龄>60岁、合并恶性肿瘤、有利奈唑胺用药史是发生LRCoNS感染的独立危险因素。结论45株LRCoNS的耐药基因主要是23S rRNA基因第V功能区突变和cfr基因,菌种同源性高。年龄>60岁、合并恶性肿瘤、有利奈唑胺用药史是发生LRCoNS感染的独立危险因素。Objective To observe the resistance genes and strain homology of Linezolid-resistant coagulase-negative Staphylococci(LRCoNS),and to analyze the risk factors of LRCoNS infection.Methods The drug resistance of 45 LRCoNS strains was observed by drug sensitivity test,drug resistance gene was observed by PCR,and the homology of strains was observed by pulse field gel electrophoresis.Clinical data of 45 patients with LRCoNS infection and 90 patients with Linezolid-sensitive coagulase-negative Staphylococci(LSCoNS)infection were collected.Multivariate Logistic regression analysis was used to analyze the risk factors of LRCoNS infection.Results The 45 strains of LRCoNS were highly resistant toβ-lactam antibiotics,ciprofloxacin and clindamycin,and were more susceptible to vancomycin,tigecycline,rifampicin and tetracycline.Among the 45 LRCoNS,21 carried the cfr gene,4 carried the optrA gene,33 had mutations in different alleles in the V functional region of 23S rRNA,20 strains had ribosomal protein L3 gene site mutations,and 4 strains had ribosome protein L4 gene site mutations,and the multidrug resistance gene poxtA was not detected.The similarity of 24 Staphylococcus capitis strains was>90%,the similarity of 13 of the 14 Staphylococcus epidermidis strains was>90%,and the similarity of 4 of the 6 Staphylococcus korii strains was>90%.Age>60 years,coexisting malignant tumors,and history of linezolid use were independent risk factors for LRCoNS infection.Conclusions The drug resistance genes of the 45 strains of LRCoNS are mainly mutations in the V functional region of 23S rRNA gene and cfr gene,with high bacterial species homology.Age>60 years,coexisting malignant tumors,and history of linezolid use are independent risk factors for LRCoNS infection.

关 键 词：利奈唑胺 凝固酶阴性葡萄球菌 耐药基因 菌种同源性 

分 类 号：R446.5[医药卫生—诊断学]