儿童急性血源性骨髓炎MRSA分离株耐药性及其毒力基因  

Drug resistance and virulence genes in MRSA strains isolated from children with acute hematogenous osteomyelitis

作　　者：罗玉兰 吴盼 方剑[2] 罗玉方 吕霞[1] LUO Yu-lan;WU Pan;FANG Jian;LUO Yu-fang;LYU Xia(Quzhou People's Hospital,Quzhou,Zhejiang 324000,China)

机构地区：[1]衢州市人民医院骨二科,浙江衢州324000 [2]衢州市人民医院胃肠外科,浙江衢州324000 [3]衢州市人民医院急诊科,浙江衢州324000

出　　处：《中华医院感染学杂志》2023年第13期2061-2065,共5页Chinese Journal of Nosocomiology

基　　金：衢州市科技基金资助项目(2019ASA90099)。

摘　　要：目的探究儿童急性血源性骨髓炎耐甲氧西林金黄色葡萄球菌(MRSA)分离株耐药性及其毒力基因。方法以2017年2月-2019年12月衢州市人民医院102例SA感染的急性血源性骨髓炎患儿为研究对象,根据SA甲氧西林耐药性将SA感染患儿分为MRSA组43例、甲氧西林敏感金黄色葡萄球菌(MSSA)组59例,比较两组毒力基因阳性率,并分析毒力基因与SA甲氧西林耐药性及疾病严重程度和患者预后的关系。结果SA感染患儿中MSSA检出率高于MRSA,MRSA组对苯唑西林、头孢西丁、头孢唑林、头孢呋辛等抗菌药物的耐药性高于MSSA组(P<0.05);Psm-mec阳性是影响SA甲氧西林耐药性的危险因素(P<0.05);Psm-mec阳性率随急性血源性骨髓炎患儿病情严重程度的加重而升高,pvl阳性率随疾病严重程度的加重而降低(P<0.05);Psm-mec阳性是影响急性血源性骨髓炎严重程度的危险因素,pvl为保护因素(P<0.05);预后较好组及预后不良组的sasX、Psm-mec、pvl阳性率比较,无统计学差异。结论儿童急性血源性骨髓炎SA感染甲氧西林耐药性较高,其毒力基因与MRSA及疾病严重程度有关。OBJECTIVE To explore the drug resistance and virulence genes in methicillin-resistant Staphylococcus aureus(MRSA)strains isolated from children with acute hematogenous osteomyelitis.METHODS A total of 102 acute hematogenous osteomyelitis children with S.aureus infection who were treated in Quzhou People's Hospital from Feb 2017 to Dec 2019 were recruited as the research subjects and were divided into the MRSA group with 43 cases and the methicillin-sensitive S.aureus(MSSA)group with 59 cases according to the result of methicillin resistance testing for the S.aureus strains.The positive rates of virulence genes were compared between the two groups,and the relationship between the virulence genes and the methicillin resistance in S.aureus strains,severity of disease and prognosis was observed.RESULTS Among the children with S.aureus infection,the isolation rate of MSSA was higher than that of the MRSA.The drug resistance rates of the MRSA strains to oxacillin,cefoxitin,cefazolin and cefuroxime were significantly higher than those of the MSSA strains(P<0.05).The positive test of Psm-mec was a risk factor for the methicillin resistance in S.aureus strains(P<o.05);the positive rate of Psm-mec was increased with the aggravation of illness condition of the children with acute hematogenous osteomyelitis,while the positive rate of pul was decreased with the aggravation of illness condition(P<0.05).The positive test of Psm-mec was a risk factor affecting the severity of acute hematogenous osteomyelitis,and pol was a protective factor(P<0.05).There were no significant differences in the positive rates of sas X,Psm-mec and pul between the favorable prognosis group and the poor prognosis group.CONCLUSION The acute hematogenous osteomyelitis children with S.aureus infection show high drug resistance rate to methicillin,and the virulence genes are associated with the MRSA and severity of disease.

关 键 词：金黄色葡萄球菌感染 毒力基因 儿童急性血源性骨髓炎 相关性 sasX Panton-Valentine杀白细胞素 酚溶调制肽 

分 类 号：R725.5[医药卫生—儿科]