感染性心内膜炎患者分离金黄色葡萄球菌耐药性及毒力因子分析  

Drug Resistance and Virulence Factors of Staphylococcus Aureus Isolated from Patients with Infective Endocarditis

作　　者：韩晶[1] 刘晶[1] 杨自坚 HAN Jing;LIU Jing;YANG Zijian(Medical Laboratory,Medical Laboratory Center of Anyang People’s Hospital,Anyang 455000,China)

机构地区：[1]安阳市人民医院医学检验中心医学检验,河南安阳455000

出　　处：《河南医学研究》2025年第6期1032-1036,共5页Henan Medical Research

摘　　要：目的分析感染性心内膜炎(IEC)患者分离金黄色葡萄球菌(SA)耐药性及毒力因子水平。方法收集2021年1月至2023年1月安阳市人民医院医学检验中心收治的IEC患者血液标本中分离出的92株SA,采用仪器法和纸片法进行菌株鉴定和药敏试验,多重聚合酶链反应(PCR)检测菌株毒力因子基因[纤黏蛋白原凝集素A(clfA)、溶血毒素(hld)、纤黏蛋白原凝集素B(clfB)、肠毒素B(seb)、肠毒素A(sea)、杀白细胞素(pvl)、中毒休克综合征毒素(tsst-I)],按耐药性分为耐甲氧西林金黄色葡萄球菌(MRSA)组和甲氧西林敏感的金黄色葡萄球菌(MSSA)组,分析SA的耐药性及毒力因子水平。结果92株SA对利奈唑胺、替加环素、万古霉素敏感率均为100.00%,对莫西沙星、利福平、庆大霉素、左氧氟沙、四环素、环丙沙星、复方新诺明及苯唑西林的敏感率高于72.00%,对克林霉素和红霉素的敏感率均低于53.00%,对青霉素的敏感率仅为14.13%。92株SA中,27株为MRSA(27/92,29.35%,MRSA组),65株为MSSA(65/92,70.65%,MSSA组);MSSA组对四环素、苯唑西林、克林霉素、红霉素及青霉素的敏感率均高于MRSA组,差异有统计学意义(P<0.05)。92株SA中7种毒力因子基因均能检出,阳性率从高到低依次是clfA(90.22%)、hld(85.87%)、clfB(80.43%)、seb(67.39%)、sea(33.70%)、pvl(13.04%)、tsst-I(6.65%)。MRSA组毒力因子clfB阳性率(66.67%)低于MSSA组(86.15%),seb阳性率(96.30%)和tsst-I阳性率(22.22%)高于MSSA组(55.38%、0),差异有统计学意义(P<0.05)。MRSA组携带2种毒力因子的比率(3.70%)低于MSSA组(20.00%),携带5种毒力因子的比率(29.63%)高于MSSA组(10.77%),差异有统计学意义(P<0.05)。结论IEC患者标本中分离出的SA对利奈唑胺、替加环素、万古霉素和奎奴普丁/达福普汀高度敏感,但MRSA组菌株的敏感率普遍低于MSSA组,其耐药机制可能与毒力因子clfB、seb、tsst-I携带率及携带毒力因子数目有关。Objective To analyze the drug resistance and virulence factors of Staphylococcus aureus(SA)isolated from patients with infective endocarditis(IEC).Methods A total of 92 strains of SA isolated from different samples of patients with IEC admitted to Medical Laboratory Center of Anyang People’s Hospital from January 2021 to January 2023 were collected,and strain identification and drug sensitivity test were performed by instrument method and paper disk method.Multiple polymerase chain reaction(PCR)was used to detect virulence factors genes[fibrinogen agglutinin A(clfA),hemolysin(hld),fibrinogen agglutinin B(clfB),enterotoxin B(seb),enterotoxin A(sea),leukocidin(pvl),toxic shock syndrome toxin(tsst-I)].According to drug resistance,they were divided into methicillin-resistant staphylococcus aureus(MRSA)group and methicillin-sensitive staphylococcus aureus(MSSA)group,and the drug resistance and virulence factors of SA were analyzed.Results The sensitivity rates of 92 SA strains to linezolid,tigacycline,vancomycin and quinupristin/dalfopristin were all 100.00%,and the sensitivity rates to moxifloxacin,rifampicin,gentamicin,levofloxacin,tetracycline,ciprofloxacin,compound sulfamethoxazole and oxacillin were higher than 72.00%,and the sensitivity rates to clindamycin and erythromycin were lower than 53.00%,and the sensitivity rate to penicillin was only 14.13%.Among 92 SA strains,there were 27 strains of MRSA(27/92,29.35%,MRSA group)and 65 strains of MSSA(65/92,70.65%,MSSA group).The sensitivity rates to tetracycline,oxacillin,clindamycin,erythromycin and penicillin in MSSA group were higher than those in MRSA group(P<0.05).All 7 virulence factors genes in 92 strains of SA could be detected,and the positive rates from high to low were clfA(90.22%),hld(85.87%),clfB(80.43%),seb(67.39%),sea(33.70%),pvl(13.04%)and tsst-I(6.65%).The positive rate of virulence factor clfB(66.67%)in MRSA group was lower than that in MSSA group(86.15%)while the positive rates of seb(96.30%)and tsst-I(22.22%)were higher than those in MSSA group(

关 键 词：感染性心内膜炎 金黄色葡萄球菌 耐药性 毒力因子 耐甲氧西林金黄色葡萄球菌 

分 类 号：R446.5[医药卫生—诊断学]