哺乳期乳腺脓肿分离的金黄色葡萄球菌耐药性与毒力基因研究

Study on resistance and virulence genes of Staphylococcus aureus isolated from breast abscess during lactation

目的研究哺乳期乳腺脓肿分离的金黄色葡萄球菌耐药性和毒力基因,为临床治疗提供参考依据。方法收集2015年1月至2017年12月我院乳腺科哺乳期妇女发生乳腺脓肿后分离到的金黄色葡萄球菌,包括耐甲氧西林金黄色葡萄球菌(MRSA)60株和甲氧西林敏感金黄色葡萄球菌(MSSA)64株,用聚合酶链反应(PCR)的方法分析mecA、hla、pvl、clfA、nuc、sea、psm-mec基因。结果 MRSA和MSSA菌株对青霉素(≥90.6%)和红霉素(≥59.4%)的耐药率较高,对利福平、磺胺甲噁唑/甲氧苄啶、莫西沙星、替加环素、万古霉素和利奈唑烷的敏感性较高(≥98.3%)。MRSA对克林霉素、四环素的耐药率明显高于MSSA (P<0.05)。60株MRSA经mecA基因检测均为阳性,64株MSSA均为阴性。Hla、clfA、nuc毒力因子在MSSA和MRSA中均具有较高的携带率(≥98.3%),MRSA携带毒力因子pvl明显低于MSSA (P<0.05)。结论 MRSA携带mecA基因,对克林霉素、四环素的耐药率高于MSSA;MRSA毒力因子pvl携带率低于MSSA,临床应针对哺乳期乳腺脓肿进行MRSA防控,同时需监测MSSA携带毒力基因的状况,评估患者的预后。

Objective To study the drug resistance and virulence genes of Staphylococcus aureus isolated from breast abscess during lactation,and to provide reference basis for clinical treatment.Methods Staphylococcus aureus i-solated from breast-feeding women with breast abscesses from January 2015 to December 2017 in Department of Breast in our hospital were collected,and their susceptibility results were obtained.Totally 60 methicillin-resistant Staphylococ-cus aureus(MRSA)strains and 64 methicillin-sensitive Staphylococcus aureus(MSSA)strains were selected,and the mecA,hla,pvl,clfA,nuc,sea,and psm-mec genes were analyzed by polymerase chain reaction(PCR).Results MRSA and MSSA had high drug resistance to penicillins(≥90.6%)and erythromycin(≥59.4%),while they had high sen-sitivity to rifampin,trimethoprim-sulfamethoxazole,moxifloxacin,tigecycline,vancomycin and linezolid(≥98.3%).The resistance rates to clindamycin and tetracycline in MRSA were higher than in MSSA(P<0.05).Sixty strains of MRSA were all positive by mecA gene test,and 64 strains of MSSA were negative;hla,clfA and nuc virulence factors were highly carried in MSSA and MRSA(≥98.3%);MRSA carrying virulence factor pvl was significantly lower than MSSA(P<0.05).Conclusion MRSA carries mecA gene,and the resistance rate to clindamycin and tetracycline in MRSA is higher than in MSSA;the carrying rate of virulence factor pvl in MRSA is lower than in MSSA.It is necessa-ry to strengthen clinical control of MRSA infection for women with breast abscess in lactation period and monitor MSSA virulence genes to assess the prognosis of patients.