烧伤患者MRSA感染的影响因素及其耐药基因与毒力基因

Influencing factors of MRSA infection and its drug resistance genes and virulence genes in burn patients

目的 分析烧伤患者医院耐甲氧西林金黄色葡萄球菌(MRSA)感染的影响因素及其耐药基因和毒力基因。方法 选取2019年5月-2021年5月大庆油田总医院收治的医院感染MRSA烧伤患者95例作为研究对象,设为研究组,并选取同期医院感染甲氧西林敏感金黄色葡萄球菌(MSSA)的烧伤患者80例作为对照组,收集两组资料归纳烧伤患者MRSA感染的影响因素,分析MRSA、MSSA耐药性;并运用聚合酶链式反应(PCR)法检测耐药基因和毒力基因状况。结果 烧伤患者MRSA感染检出率为54.29%;抗菌用药时间、侵入性操作、贫血、低蛋白血症是烧伤患者MRSA感染的影响因素(P<0.05);MRSA对青霉素、苯唑西林、四环素、庆大霉素、环丙沙星、左氧氟沙星、利福平、克林霉素及红霉素的耐药率均>70.00%;MRSA携带的毒力基因有sea、hla和pvl,携带率分别为100.00%、100.00%和60.00%;MRSA携带的耐药基因有mecA、aac(6′)/aph(2′′)、ermA/B/C、tet/M、aph(3′)-Ⅲ和qacA/B,携带率分别为100.00%、100.00%、100.00%、100.00%、96.84%和86.32%。结论 抗菌用药时间、侵入性操作、贫血、低蛋白血症是烧伤患者MRSA感染的影响因素,且MRSA携带耐药基因和毒力基因,提示MRSA具有较强的宿主组织损伤特性,临床应根据病情和药敏试验合理选用抗菌药物,以降低MRSA感染。

OBJECTIVE To analyze the factors influencing in-hospital methicillin-resistant Staphylococcus aureus(MRSA) infection in burn patients and its drug resistance and virulence genes.METHODS Ninety-five burn patients with hospital-acquired MRSA infection who were admitted to Daqing Oilfield General Hospital from May 2019 to May 2021 were selected as the study subjects and set as the study group,and 80 burn patients with hospital-acquired methicillin-sensitive Staphylococcus aureus(MSSA) infection during the same period were selected as the control group.The data of both groups were collected to summarize the influencing factors of MRSA infection in burn patients,and the drug resistance of MRSA and MSSA was analyzed.The status of drug resistance genes and virulence genes were detected by polymerase chain reaction(PCR) method.RESULTS The detection rate of MRSA infection in burn patients was 54.29%.Time of antimicrobial administration,invasive procedures,anemia,and hypoproteinemia were the influencing factors of MRSA infection in burn patients(P<0.05).The resistance rates of MRSA to penicillin,oxacillin,tetracycline,gentamicin,ciprofloxacin,levofloxacin,rifampicin,clindamycin,and erythromycin were higher than 70.00%.The virulence genes carried by MRSA were sea,hla and pvl,with carriage rates of 100.0%,100.0% and 60.00%,respectively.The drug resistance genes carried by MRSA were mecA,aac(6′)/aph(2′′),ermA/B/C,tet/M,aph(3′)-Ⅲ and qacA/B,with carriage rates of 100.0%,100.0%,100.0%,100.0%,96.84% and 86.32%,respectively.CONCLUSION The duration of antimicrobial medication,invasive procedures,anemia,and hypoproteinemia were the influencing factors of MRSA infection in burn patients.MRSA carried drug resistance and virulence genes,suggesting that MRSA had strong host tissues damage characteristics,and clinical antibacterial drugs should be selected reasonably according to the condition and drug susceptibility test to reduce MRSA infection.