创伤患者金黄色葡萄球菌感染的分子流行病学研究

Staphylococcus aureus Infection in Traumatic Patients: A Molecular Epidemiological Study

目的 通过对创伤病房金黄色葡萄球菌 (SA )感染的分子流行病学研究 ,为临床预防和治疗 SA感染提供科学依据。方法 收集创伤病房近 3年 SA培养阳性病例 2 9例 ,采用多重 PCR扩增 SA的毒素基因 tst和 sec,分析毒素基因的存在与发热的关系 ;通过 PCR扩增 MRSA基因组稀有限制区旁的 DNA序列 ,对 MRSA进行基因分型。结果 2 9例患者中 ,12例为甲氧西林敏感金黄色葡萄球菌 (MSSA ) ;17例为耐甲氧西林金黄色葡萄球菌 (MRSA ) ;MRSA携带 tst和 sec基因比率 (均为 88.2 % )显著高于 MSSA (分别为 33.3%和 4 1.7% ,P =0 .0 14 ) ;19例伴有发热 ,其中 16例含有 tst和 sec基因 ,10例不伴发热 ,其中 4例含 tst和 sec基因 ,发热组携带两种基因比率显著高于不发热组 (P =0 .0 32 ) ;稀有限制区 PCR(IRS- PCR)分型表明 2 0 0 1年感染 MRSA的 10例患者有 8例为同种基因型。结论 tst和 sec基因的存在可能与金黄色葡萄球菌引起的发热有关 ,2 0 0 1年创伤病房可能存在 MRSA暴发流行。

OBJECTIVETo investigate molecular epidemiological characteristics of Staphylococcus aureus (SA) infection in traumatic ward. METHODSA total of 29 patients in recent 3 years in traumatic ward were studies. Toxin genes, including tst and sec genes, were amplified by using multiple PCR and the relationship between the presence of the two genes and fever was analyzed. In the mean time, meticillin-resistant S. aureus (MRSA) were genotyped by infrequent restriction site PCR (IRS-PCR). RESULTSAmong 29 patients, 17 patients were MRSA, which took tst and sec genes in rate of 88.2%, 12 patients were meticillin-susceptibile Saureus (MSSA), which took tst and sec genes in rate of 33.3% and 41.7%, the two rates had significantly difference (P= 0.014); 19 patients with fever, among them 16 patients took tst and sec genes: 10 patients without fever, from them 4 patients took tst and sec genes, the two groups had significantly difference (P=0.032); by IRS-PCR, 8 patients with MRSA infection had identical genotype in 2001. CONCLUSIONSThe presence of tst and sec genes may be associated with the incidence of febrile infection cases caused by SA. Genotyping of MRSA by IRS-PCR revealed an outbreak of MRSA infection at traumatic ward in 2001.