金黄色葡萄球菌sasX、psm-mec、pvl三种毒力基因的检测与分析

摘要：目的：分析54株金黄色葡萄球菌的mecA基因与sasX、psm mec、pvl三种毒力基因分布及临床相关性。 方法：收集2013年1～5月南京医科大学第一附属医院临床分离的54株金黄色葡萄球菌,用PCR及测序的方法分析mecA、sasX、psm-mec、pvl基因的携带情况,并结合患者的临床资料,探讨其临床相关性。 结果：54株金黄色葡萄球菌中有23株mecA基因检测阳性,31株mecA基因阴性。mecA基因阳性菌株较mecA基因阴性株体外药敏试验呈多重耐药表型。sasX基因阳性1株,阳性率为1.9%;psm-mec基因阳性10株,阳性率为18.5%;pvl基因阳性38株,阳性率为70.4%。mecA基因阳性菌株psm-mec基因阳性率显著高于mecA基因阴性菌株（P<0.01）,pvl基因阳性率显著低于mecA基因阴性菌株（P<0.05）。mecA基因和psm-mec基因与临床感染严重程度显著相关（P均<0.01）。 结论：联合检测mecA、psm-mec和pvl基因有利于金黄色葡萄球菌感染的诊断、治疗和预后综合评估。     

金黄色葡萄球菌肺炎并金黄色葡萄球菌性败血症二例报告

金黄色葡萄球菌肺炎(金葡菌肺炎)是由金黄色葡萄球菌所引起的急性化脓性肺部感染，常发生于免疫功能受损的患者。金葡菌肺炎病情较重，易并发金葡菌性败血症，病死率较高。2003年我科收治了金黄色葡萄球菌肺炎并金黄色葡萄球菌性败血症患者两例。现报告如下：     

金黄色葡萄球菌肺炎 30例临床分析

目的通过分析对比不同途径导致的金黄色葡萄球菌肺炎发生的高危因素、临床特点和治疗过程,提高对金黄色葡萄球菌肺炎的认识.方法对 30例金黄色葡萄球菌肺炎患者的临床资料进行回顾性分析.结果吸入性和血源性金黄色葡萄球菌肺炎在诱因、临床表现、 X线特点等多方面都有不同的特点.医院内获得性金黄色葡萄球菌肺炎的发生与侵入治疗、抗菌素的应用等医源因素相关,且 MRSA的发生率明显升高.结论金黄色葡萄球菌肺炎预后差、死亡率高,应结合其临床特点早期明确诊断;早期、大剂量应用敏感抗菌素是治疗关键,对危重患者,尚应联合用药.此外,尚须重视院内感染的防范.     

静脉药瘾者血源性金黄色葡萄球菌肺炎

我院自1993年6月～1997年6月收治静脉药瘾者血源性金黄色葡萄球菌（金葡菌）肺炎8例。报道如下。1临床资料1．1一般资料：8例中，男7例，女1例。年龄18～35岁。均有吸食海洛因史，发病前均改吸食为静脉注射，均有使用不洁注射器史。注射溶剂为冷开水、矿泉水。1．2临床表现：8例均有畏寒、发热（起病时体温37.8～41℃，热型均不规则）、咳嗽、咳痰（黄色脓性痰）、胸痛、气促和心悸。全身不适、肌肉酸痛6例，咯血4例，皮肤出血点或瘀斑2例，皮疹1例，病程中出现急腹痛2例。8例均有肺部湿性罗音和窦性心动过速，三尖瓣区心脏收缩期杂音6例，…     

小儿金黄色葡萄球菌肺炎76例临床分析

金黄色葡萄球菌肺炎(以下简称金葡萄肺炎)是由金黄色葡萄球菌引起的肺炎。病变发展迅速,多数有严亚的并发症,因此,掌握本症的特点,做到早期诊断,早期治疗十分重要,现将我院1980年元月至1994年12月15年间资料较完整的76例分析报道如下。 1 临床资料 1.1 一般资料:76例中男42例,女34例。年龄2～6月14例,6月～2岁26例,～3岁10例,～7岁10例,～9岁8例,～12岁8例。各季节均有发病,以     

金黄色葡萄球菌生物膜产生及相关毒力因子研究

目的 金黄色葡萄球菌引起的感染遍及临床各科,人体各部位。对临床分离的金黄色葡萄球菌进行生物膜、生物膜相关因子及毒力因子检测；方法 刚果红培养基法进行生物膜筛选；用电子显微镜观察生物膜的形成；用PCR方法检测生物膜相关基因及毒力因子。结果 100株金黄色葡萄球菌中,63株产生生物膜,产生物膜率达63.0％,均产生与生物膜高度相关的icaA基因、icaD基因；还可产生ebh、sea、seb、pvl、hla、fnbA 等毒力因子；产生物膜的菌中MRSA菌株占51.2%,MSSA占48.8%；结论 产生物膜的金黄色葡萄球菌已经成为医院感染的致病因素之一,常产生各种毒力因子。     

源自皮肤分泌物的金黄色葡萄球菌毒力因子研究

目的:对分离自皮肤分泌物标本的金黄色葡萄球菌进行毒力基因检测,初步探讨并分析这些毒力因子的分布与相应的皮肤病种类及患者年龄间的关系。方法:收集新华医院临床微生物实验室2010年12月至2012年4月从皮肤科患者的皮肤分泌物标本分离得到的100株不重复的金黄色葡萄球菌。采用聚合酶链反应(PCR)检测这100株细菌的eta、etb、sea、seb、sec、seh、pvl和tst这8种毒力基因,并对其进行基因测序。结果:sec、seb、seh、sea、eta、tst、pvl、etb基因检出率依次为16%、15%、14%、12%、3%、2%、2%、1%。其中分离自特应性皮炎患者的金黄色葡萄球菌检出毒力基因eta、sea、seb、sec、seh和pvl,分离自银屑病患者的菌株检出毒力基因seb、sec和tst,分离自葡萄球菌性烫伤样皮肤综合征患者的菌株检出毒力基因eta、etb、sea、seb、sec和pvl,分离自湿疹患者的菌株检出毒力基因sea、seb、sec和seh,而分离自天疱疮及类天疱疮患者的菌株仅检出毒力基因sec。结论:分离自皮肤病分泌物标本的金黄色葡萄球菌中各毒力基因的分布与相应的皮肤病种类及患者年龄间有一定相关性。     

儿童感染金黄色葡萄球菌的耐药性分析

目的了解儿童感染的金黄色葡萄球菌(staphylococcus aureus,SA)对常用抗生素的耐药性,为临床合理用药提供参考。方法从我院2007~2009年住院患儿送检标本中分离出SA150株,采用纸片扩散法(K-B法)检测14种抗菌药物的敏感性,并运用WHONET5.3软件对药敏结果进行统计分析。结果分离出的150株SA中,甲氧西林敏感金黄色葡萄球菌(methicillin senstive suaphylococcus aureus,MSSA)77株,占51.3%;耐甲氧西林金黄色葡萄球菌(MRSA)73株,占48.7%。MRSA对几种常用抗菌药物的耐药率明显高于MSSA,差异有统计学意义(P<0.05);未发现耐替考拉宁和万古霉素的SA。结论儿童感染的SA对大部分抗生素敏感,但MRSA耐药较为严重,临床使用抗生素时应根据药敏试验结果审慎选择。     

Staphylococcus aureus decolonization for recurrent skin and soft tissue infections in children

Question I see otherwise healthy children in my practice with recurrent staphylococcal skin infections. While I am comfortable with managing each acute infection, what can be done to eradicate Staphylococcus aureus and reduce the chance of recurrent infections?AnswerStaphylococcus aureus skin and soft tissue infections (SSTIs) are common in children and are increasing in frequency. Risk factors for the development of staphylococcal SSTIs are colonization with S aureus and recent diagnosis of SSTI in a household member. Current evidence suggests that a combined strategy using hygiene education, nasal mupirocin, and bath washes with chlorhexidine or diluted bleach has the most success in decolonization. However, decolonization appears to only provide temporary reduction in carriage rate. According to the limited research in the ambulatory population, decolonization of a patient does not confer a reduced risk of recurrent infections. Further research and large studies are required to understand the factors in S aureus pathogenesis and whether decolonization of a child and his or her household is of benefit in reducing subsequent S aureus infections.     

Methicillin-resistant Staphylococcus aureus infection epidemiology and clinical response from tigecycline soft tissue infection trials

Given increasing resistance, therapeutic options to treat MRSA soft tissue infections should be evaluated. This pooled analysis evaluated data from subjects enrolled in 6 tigecycline clinical trials with documented MRSA complicated skin and skin structure infections or diabetic foot infections (DFIs). Baseline characteristics were compared between subjects with and without molecularly classified community-acquired (CA) MRSA, specifically staphylococcal cassette chromosome mec (SCCmec) IV. Clinical response was compared by CA-MRSA designation and treatment group. A total of 378 subjects with MRSA soft tissue infections were identified, including 79 with DFI. A total of 249 (65.9%) were molecularly classified as CA-MRSA. Clinical response rates for MRSA soft tissue infection were similar between tigecycline and vancomycin (treatment difference, 1.0%; 95% confidence interval: −9.3, 12.0) as well as by infection type, SCCmec, and Panton-Valentine leukocidin (PVL) status. Tigecycline demonstrated comparable efficacy for treatment of MRSA soft tissue infections regardless of infection type, SCCmec, or PVL status.     

Mupirocin resistance in Staphylococcus aureus causing recurrent skin and soft tissue infections in children

Staphylococcus aureus resistance to mupirocin is often caused by acquisition of a novel isoleucyl-tRNA synthetase encoded on the plasmid gene mupA. We tested S. aureus isolates from children at Texas Children's Hospital with recurrent skin and soft tissue infections for mupirocin resistance and mupA. Of 136 isolates, 20 were resistant to mupirocin (14.7%). Fifteen isolates (11%) carried mupA, and the gene was more common in methicillin-susceptible S. aureus (21.4%) than methicillin-resistant S. aureus (8.3%; P=0.03). Seven of 20 mupirocin-resistant isolates displayed clindamycin resistance.     

住院患儿皮肤软组织感染金黄色葡萄球菌临床特征及耐药性分析

摘要 目的 了解海口市妇幼保健院住院患儿皮肤软组织感染金黄色葡萄球菌临床分布及耐药性,为指导临床抗菌药物的合理使用提供依据。方法 收集2013-2017年皮肤软组织感染患儿临床资料,分析病原菌分布及金黄色葡萄球菌药敏试验结果。结果 从973份送检标本中共分离金黄色葡萄球菌297株,检出率为30.52%。其中检出耐甲氧西林金黄色葡萄球菌(MRSA)119株,占金黄色葡萄球菌的40.06%。MRSA主要来源于外科、年龄≤1岁和发生复杂性软组织感染的患者,其检出率分别为14.20%、25.27%和27.20%。金黄色葡萄球菌对16种常用抗菌药物的耐药性5年内未发生明显变化,对青霉素G耐药率高达96.30%~100.00%;对红霉素的耐药率达64.80%~77.90%;对利福平、莫西沙星的耐药率均<10.00%;对利奈唑胺、替加环素、万古霉素、呋喃妥因和喹努普汀/达福普汀均未产生耐药性。结论 住院患儿皮肤软组织感染金黄色葡萄球菌中MRSA所占比例较高,应依据药敏结果合理用药,需重点关注外科低龄患儿复杂性软组织感染MRSA的预防和控制。     

Methicillin-resistant Staphylococcus aureus skin and soft tissue infections. Impacting patient care

With the emergence and rising prevalence of methicillin-resistant Staphylococcus aureus among individuals in the community, it is imperative to standardize patient care and develop best practices among health care providers. Evidence-based standard patient care guidelines for community-acquired methicillin-resistant S aureus skin and soft tissue infections have the potential to positively impact patient outcomes, decrease health risk, reduce hospitalization from insufficient treatment, and decrease or even prevent further transmission to unaffected individuals. Emergency department providers are in a unique position to lead in the management and prevention of skin and soft tissue infections. It is essential that community-acquired methicillin-resistant S aureus skin and soft tissue infections are consistently treated by evidence-based treatment standards, especially with the growing number of pathogens displaying resistance to antibiotics, rising mortality, rapid spread of antimicrobial resistant microbes, and the escalating health care costs. The purpose of this literature review is to provide health care providers with current evidence-based health care guidelines for the treatment and management of community-acquired methicillin-resistant S aureus skin and soft tissue infections.     

金黄色葡萄球菌耐药基因及致病毒素基因的相关性研究

目的研究携带TSST-1和PVL基因的金黄色葡萄球菌耐药特点、分布特征及与致病性的关系。方法临床收集74株金黄色葡萄球菌,采用PCR法检测TSST-1、PVL和mecA基因,纸片扩散法进行17种抗菌剂的耐药性检测。结果 74株金黄色葡萄球菌中mecA基因检出率为55.4%,其中22株检出PVL基因(30.3%),PVL阳性的耐甲氧西林金黄色葡萄球菌(MRSA)为15株(36.6%),甲氧西林敏感的金黄色葡萄球菌(MSSA)为7株(21.2%),两者间差异无统计学意义(P>0.05)。5株金黄色葡萄球菌中检出TSST-1基因(6.3%),均为MRSA。MRSA耐药性严重,并呈多重耐药性,携带基因PVL和TSST-1的MRSA除对万古霉素敏感外,对其他抗菌剂均耐药。结论携带基因TSST-1和PVL的金黄色葡萄球菌耐药性及致病力更强,增加了临床抗感染治疗的难度。