金黄色葡萄球菌耐药性与耐药基因和毒力基因的相关性

doi:10.3969/j.issn.1673-8640.2023.04.011

摘要/Abstract

摘要：

目的了解不同耐药情况的金黄色葡萄球菌耐药基因和毒力基因携带情况，探讨耐药基因和毒力基因与金黄色葡萄球菌耐药的相关性。方法收集2018年1月— 2021年1月皖南医学院第二附属医院临床分离耐甲氧西林金黄色葡萄球菌（MRSA）和甲氧西林敏感金黄色葡萄球菌（MSSA）各110株，采用聚合酶链反应（PCR）检测耐药基因mecA、mecC、ermA和毒力基因SEA。结果 MSSA对青霉素耐药率较高，对氯霉素类、四环素类、喹诺酮类、磺胺类、氨基糖苷类抗菌药物耐药率均较低；MRSA对苯唑西林和青霉素的耐药率均为100%，且对多种抗菌药物耐药率均较高。MRSA耐药基因和毒力基因携带率均显著高于MSSA（P<0.01）。携带mecA耐药基因的金黄色葡萄球菌耐药性明显高于未携带mecA耐药基因的金黄色葡萄球菌（P<0.01）。携带SEA毒力基因和ermA耐药基因的金黄色葡萄球菌对除复方磺胺甲噁唑外的抗菌药物的耐药性均高于未携带这2种基因的菌株（P<0.05）。结论携带耐药基因mecA、mecC、ermA和毒力基因SEA与金黄色葡萄球菌耐药有一定的相关性。

关键词: 金黄色葡萄球菌, 耐甲氧西林金黄色葡萄球菌, 甲氧西林敏感金黄色葡萄球菌, 耐药基因, 毒力基因, 耐药性

Abstract:

Objective To analyze the distribution of drug resistance genes and virulence genes of different drug resistant Staphylococcus aureus，and to investigate the correlation between drug resistance genes，virulence genes and drug resistance. Methods Totally，220 isolates of Staphylococcus aureus isolated in the Second Affiliated Hospital of Wannan Medical College from January 2018 to January 2021 were collected and classified into methicillin-resistant Staphylococcus aureus（MRSA，110 isolates） and methicillin-sensitive Staphylococcus aureus（MSSA，110 isolates）. The drug resistance genes（mecA，mecC and ermA） and virulence gene（SEA） were determined by polymerase chain reaction（PCR）. Results Among the 220 isolates of Staphylococcus aureus，MSSA had a high drug resistance rate to penicillin，there were low drug resistance rates to chloramphenicol，tetracycline，quinolone，sulfonamide and aminoglycoside. MRSA had high drug resistance rates to many types of antibacterial drugs，and the drug resistance rates to oxacillin and penicillin were 100%. Among MRSA isolates，the rates of carrying drug resistance genes and virulence genes were higher than those of MSSA isolates（P<0.01）. The drug resistance of Staphylococcus aureus with mecA drug resistance gene was higher than that of Staphylococcus aureus without mec A（P<0.01）. The drug resistance rates of Staphylococcus aureus with SEA virulence gene and ermA drug resistance gene，except for compound trimethoprim，were higher than those of Staphylococcus aureus without SEA virulence gene and ermA drug resistance gene（P<0.05）. Conclusions Drug resistance genes，mecA，mecC and ermA，and virulence gene SEA are related to the drug resistance of Staphylococcus aureus.

Key words: Staphylococcus aureus, Methicillin-resistant Staphylococcus aureus, Methicillin-sensitive Staphylococcus aureus, Drug resistance gene, Virulence gene, Drug resistance

中图分类号:

R446.5

方咏梅, 章燕, 徐雪莹, 钟峰. 金黄色葡萄球菌耐药性与耐药基因和毒力基因的相关性[J]. 检验医学, 2023, 38(4): 357-361.

FANG Yongmei, ZHANG Yan, XU Xueying, ZHONG Feng. Correlation of Staphylococcus aureus drug resistance with drug resistance genes and virulence genes[J]. Laboratory Medicine, 2023, 38(4): 357-361.

图/表 5

参考文献 14.

1.	Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing; twenty-fifth informational supplement[S]. M100-S25,CLSI, 2015.
2.	WALTERS M S, EGGERS P, ALBRECHT V, et al. Vancomycin-resistant Staphylococcus aureus-Delaware,2015[J]. MMWR Morb Mortal Wkly Rep, 2015, 64(37):1056. DOI URL
3.	HU F, GUO Y, YANG Y, et al. Resistance reported from China antimicrobial surveillance network(CHINET)in 2018[J]. Eur J Clin Microbiol Infect Dis, 2019, 38(12):2275-2281. DOI
4.	ALZOMOR O, ALFAWAZ T, ALSHAHRANI D. Invasive community-acquired methicillin-resistant Staphylococcus aureus(CA-MRSA)infection in children:case series and literature review[J]. Int J Pediatr Adolesc Med, 2017, 4(3):119-123. DOI URL
5.	胡付品, 郭燕, 朱德妹, 等. 2020年CHINET中国细菌耐药监测[J]. 中国感染与化疗杂志, 2021, 21(4):377-387. DOI
6.	SURANA K, SAGRULE D, LANJEWAR S. Primary closure with suction drain of acute breast abscess after incision,drainage,and curettage[J]. Indian J Surg, 2020, 82:129-133. DOI
7.	杨斌, 李华. 2016—2019年陕西省榆林市细菌耐药监测网成员单位金黄色葡萄球菌的临床分布与耐药性变迁[J]. 现代检验医学杂志, 2021, 36(1):81-84.
8.	ASWANI V, NAJAR F, PANTRANGI M, et al. Virulence factor landscape of a Staphylococcus aureus sequence type 45 strain,MCRF184[J]. BMC Genomics, 2019, 20(1):123. DOI
9.	林晓晖, 麦惠香, 简梦华, 等. 梅里埃VTIEK MS质谱仪在甲氧西林耐药及敏感的金黄色葡萄球菌快速鉴定的应用研究[J]. 现代检验医学杂志, 2020, 35(5):121-123.
10.	BOJER M S, FREES D, INGMER H. SosA in Staphylococci:an addition to the paradigm of membrane-localized,SOS-induced cell division inhibition in bacteria[J]. Curr Genet, 2020, 66(3):495-499. DOI
11.	ANTONANZAS F, LOZANO C, TORRES C. Economic features of antibiotic resistance:the case of methicillin-resistant Staphylococcus aureus[J]. Pharmacoeconomics, 2015, 33(4):285-325. DOI URL
12.	PARK S Y, SON J S, OH I H, et al. Clinical impact of methicillin-resistant Staphylococcus aureus bacteremia based on propensity scores[J]. Infection, 2011, 39(2):141-147. DOI URL
13.	刘柔杉, 王俊瑞. 苯唑西林敏感耐甲氧西林金黄色葡萄球菌(OS-MRSA)研究进展[J]. 中国抗生素杂志, 2021, 46(8):736-742.
14.	SHRIEF R, El KHOLY R M, RIZK M A, et al. Prevalence of tetracycline resistant genes in Staphylococcus aureusisolates from surgical site infections egypt[J]. Biosci Biotech Res Asia, 2019, 16(2):221-228. DOI URL

基因名称	引物序列（5'~3'）	产物大小/bp
mecA	F：ACGAGTAGATGCTCAATATAA	293
	R：CTTAGTTCTTTAGCGATTGC
mecC	F：GAAAAAAAGGCTTAGAACGCCTC	138
	R：GAGATCTTTTCCGTTTTCAGC
SEA	F：GGTTATCAATGTGCGGGTGG	232
	R：CGGCACTTTTTTCTCTTCGG
ermA	F：GTTCAAGAACAATCACAGAG	533
	R：GGATCAGGAAAAGGACATTTTAC

基因名称	引物序列（5'~3'）	产物大小/bp
mecA	F：ACGAGTAGATGCTCAATATAA	293
	R：CTTAGTTCTTTAGCGATTGC
mecC	F：GAAAAAAAGGCTTAGAACGCCTC	138
	R：GAGATCTTTTCCGTTTTCAGC
SEA	F：GGTTATCAATGTGCGGGTGG	232
	R：CGGCACTTTTTTCTCTTCGG
ermA	F：GTTCAAGAACAATCACAGAG	533
	R：GGATCAGGAAAAGGACATTTTAC

抗菌药物	MRSA/%	MSSA/%	χ²值	P值
苯唑西林	100.00	0	220.000	0.000
青霉素	100.00	86.36	16.098	0.000
红霉素	77.27	47.27	21.069	0.000
克林霉素	64.55	35.45	18.618	0.000
利福平	17.27	0	20.796	0.000
氯霉素	33.66	12.73	13.503	0.000
四环素	53.66	7.27	55.821	0.000
莫西沙星	55.45	10.91	49.224	0.000
万古霉素	0	0
利奈唑胺	0	0
环丙沙星	57.29	24.55	24.369	0.000
左氧氟沙星	67.27	30.91	29.101	0.000
复方磺胺甲噁唑	13.64	2.73	8.713	0.003
奎奴普丁-达福普丁	0	0
庆大霉素	32.73	6.36	24.310	0.000

抗菌药物	MRSA/%	MSSA/%	χ²值	P值
苯唑西林	100.00	0	220.000	0.000
青霉素	100.00	86.36	16.098	0.000
红霉素	77.27	47.27	21.069	0.000
克林霉素	64.55	35.45	18.618	0.000
利福平	17.27	0	20.796	0.000
氯霉素	33.66	12.73	13.503	0.000
四环素	53.66	7.27	55.821	0.000
莫西沙星	55.45	10.91	49.224	0.000
万古霉素	0	0
利奈唑胺	0	0
环丙沙星	57.29	24.55	24.369	0.000
左氧氟沙星	67.27	30.91	29.101	0.000
复方磺胺甲噁唑	13.64	2.73	8.713	0.003
奎奴普丁-达福普丁	0	0
庆大霉素	32.73	6.36	24.310	0.000

基因名称	MRSA（110株）		MSSA（110株）		χ²值	P值
基因名称	阳性/[株（%）]	阴性/[株（%）]	阳性/[株（%）]	阴性/[株（%）]	χ²值	P值
mecA	110（100.00）	0（0）	5（4.55）	105（95.45）	76.364	0.000
ermA	65（59.09）	45（40.91）	8（7.27）	102（92.73）	66.609	0.000
SEA	93（84.55）	17（15.45）	17（15.45）	93（84.55）	105.018	0.000
mecC	39（35.45）	71（64.55）	12（10.91）	98（89.09）	18.608	0.000