天津地区皮肤软组织感染分离的MRSA菌株基因分型和毒力基因及耐药性  

Genotyping, virulence genes and drug resistance of MRSA strains isolated from skin and soft tissue infection in Tianjin

作　　者：张静[1] 吴鸿滨 时涵 邢卫斌[1] 马晓芳[3] ZHANG Jing;WU Hong bin;SHI Han;XING Wei-bin;MA Xiao-fang(The Fifth Central Hospital of Tianjin,Tianjin 300450,China)

机构地区：[1]天津市第五中心医院皮肤科,天津300450 [2]天津市第五中心医院检验科,天津300450 [3]天津市第五中心医院实验室,天津300450

出　　处：《中华医院感染学杂志》2022年第12期1812-1816,共5页Chinese Journal of Nosocomiology

基　　金：天津市滨海新区卫生计生委科技基金资助项目(2017BWKY028)。

摘　　要：目的 分析本地区皮肤软组织感染分离的耐甲氧西林金黄色葡萄球菌(MRSA)菌株的基因分型、毒力基因及耐药性情况。方法 收集2019年1月-2020年12月天津市第五中心医院就诊的204例皮肤及软组织感染患者皮损分泌物,分离出MRSA菌株,所有菌株均为非重复菌株;分析MRSA菌株葡萄球菌盒式染体色mec(SCCmec)、葡萄球菌蛋白A基因(spa)基因分型及杀白细胞素(PVL)基因携带情况,并评估其与耐药性的关系。结果 204例皮肤及软组织感染患者皮损分泌物分离出82株金黄色葡萄球菌,其中MRSA有44株(53.66%),最流行的SCCmec分型为Ⅲ型,占比84.09%,最流行的spa分型为t030,占比84.09%,有5株扩增出编码毒力因子PVL基因(11.36%)。44株MRSA对万古霉素及磺胺甲噁唑/甲氧苄啶耐药性均为0,对青霉素全部耐药,不同SCCmec及spa基因分型对红霉素、头孢唑林、克林霉素、左氧氟沙星均具有较高耐药性,不同spa基因分型对克林霉素、左氧氟沙星耐药性有统计学差异(P<0.05)。PVL基因阳性对氯霉素、庆大霉素、四环素的耐药性高于PVL基因阴性(P<0.05)。结论 SCCmecⅢ型、spa t030型可能是本地区皮肤软组织MRSA感染的优势菌株,spa分型不同及PVL基因携带与否对MRSA耐药性有一定影响,但分离出的MRSA均对万古霉素及磺胺甲噁唑/甲氧苄啶敏感,可为本地区抗MRSA治疗提供参考。OBJECTIVE To investigate and analyze the genotyping, virulence genes and drug-resistant genes of methicillin resistant Staphylococcus aureus(MRSA) strains isolated from skin and soft tissue infections in this area. METHODS The skin secretions of 204 patients with skin and soft tissue infections in the Fifth Central Hospital of Tianjin between Jan. 2019 and Dec. 2020 were collected, and MRSA strains identified as non-repetitive strains were isolated. The Staphylococcal cassette chromosome mec(SCCmec) and Staphylococcal protein A gene(spa) genotyping and Panton-valentine leukocidin(PVL) gene carrying status were analyzed among the MRSA strains, and their relationship with drug resistance was analyzed. RESULTS Totally 82 strains of S. aureus were isolated from the skin secretions of 204 patients with skin and soft tissue infections, including 44 strains of MRSA(53.66%). The most common SCCmec genotype was genotype III(accounting for 84.09%) and the most common spa genotype was genotype t030(accounting for 84.09%). PVL genes encoding virulence factors were amplified in 5 strains(11.36%). The drug resistance rates of 44 MRSA strains to vancomycin and compound sulfamethoxazole were 0.00%, and all the strains were drug-resistant to penicillin. Different SCCmec and spa genotypes were highly resistant to erythromycin, cefazolin, clindamycin and levofloxacin, but the differences in drug resistance rates of different SCCmec genotypes to clindamycin and levofloxacin were significant(P<0.05). The resistance rates of strains with PVL positive genes to chloramphenicol, gentamicin and tetracycline were significantly higher than those with PVL negative genes(P<0.05). CONCLUSION Strains carrying SCCmec III and spa t030 genotypes may be the dominant strains of MRSA in skin and soft tissue infections in this area. Spa genotypes and PVL gene have certain impact on drug resistance of MRSA, and the isolated MRSA strains are all sensitive to vancomycin and compound sulfamethoxazole, which can provide a reference for anti-MRSA treatment

关 键 词：耐甲氧西林金黄色葡萄球菌 皮肤软组织感染 葡萄球菌盒式染体色mec 葡萄球菌蛋白A基因 杀白细胞素 耐药性 

分 类 号：R378[医药卫生—病原生物学]