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

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。

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

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.