血流感染金黄色葡萄球菌毒力基因分布特征

doi:10.3969/j.issn.1673-8640.2026.08.013

摘要/Abstract

摘要：

目的了解引起成人和儿童血流感染的不同类别金黄色葡萄球菌毒力基因分布特征。方法收集上海交通大学医学院附属新华医院微生物实验室保存的91株分离自血培养样本的金黄色葡萄球菌，其中耐甲氧西林金黄色葡萄球菌（MRSA）44株、甲氧西林敏感金黄色葡萄球菌（MSSA）47株。对所有菌株进行多位点序列分型（MLST）和25种毒力基因检测，结合感染者临床资料分析不同ST型别金黄色葡萄球菌毒力基因携带情况。结果 91株金黄色葡萄球菌中，溶血毒素基因hla、hlg和黏附因子相关基因ica的检出率均为100.0%，未检出etb、see基因，有5种黏附因子相关基因检出率>50%。ST1、ST5、ST22平均携带毒力基因数高于ST398和ST188（P<0.001）。PVL、clfA、clfB在儿童分离株中的检出率高于成人分离株（P值分别为<0.001、0.037、0.039），fnbA、sdrC、sdrD、sdrE在成人分离株中的检出率高于儿童分离株（P值分别为0.027、0.033、0.003和0.002）。tst、sdrE、sea、sec在MRSA中的的检出率高于MSSA（P值分别为0.006、0.039、0.042、<0.001），而can、clfB在MSSA中的检出率高于MRSA（P<0.001）。重症监护病房seg检出率高于非重症监护病房（P=0.04）。植入物感染的金黄色葡萄球菌fnbB检出率高于非植入物感染的金黄色葡萄球菌（P=0.003）。结论引起血流感染的金黄色葡萄球菌携带毒力基因数目较多，不同ST型别、人群、病区金黄色葡萄球菌携带的毒力基因存在显著差异。

关键词: 金黄色葡萄球菌, 毒力基因, 黏附因子, 溶血毒素, 肠毒素, 血流感染

Abstract:

Objective To understand the distribution characteristics of virulence genes carried by different types of Staphylococcus aureus causing bloodstream infections in adults and children. Methods A total of 91 Staphylococcus aureus isolates from blood culture samples，preserved in the Microbiology Laboratory of Xinhua Hospital of Shanghai Jiao Tong University School of Medicine，were collected，including 44 methicillin-resistant Staphylococcus aureus（MRSA） and 47 methicillin-susceptible Staphylococcus aureus（MSSA）. All the isolates were determined by multilocus sequence typing（MLST），and they were determined for 25 virulence genes，and the carriage of virulence genes among different Staphylococcus aureus ST types was analyzed in combination with clinical data from infected patients. Results The determination rates of hemolysin genes hla and hlg，as well as the adhesion-related gene ica，were all 100.0% among the 91 Staphylococcus aureus isolates，and etb and see genes were not determined. Totally，5 adhesion-related genes had determination rates >50%. The average number of virulence genes carried by ST1，ST5 and ST22 was higher than that of ST398 and ST188（P<0.001）. The determination rates of PVL，clfA and clfB in the isolates from children were higher than those from adults（P values were <0.001，0.037 and 0.039，respectively），and the determination rates of fnbA，sdrC，sdrD and sdrE in the isolates from adults were higher than those from children（P values were 0.027，0.033，0.003 and 0.002，respectively）. The determination rates of tst，sdrE，sea and sec in MRSA were higher than those in MSSA（P values were 0.006，0.039，0.042 and <0.001，respectively），while the determination rates of can and clfB in MSSA were higher than those in MRSA（P values were <0.001）. The determination rate of seg in the intensive care unit（ICU） was higher than that in non-ICU（P=0.04）. The determination rate of fnbB in Staphylococcus aureus from implantation infections was higher than that in Staphylococcus aureus from non-implantation infections（P=0.003）. Conclusions Staphylococcus aureus causing bloodstream infections carry a number of virulence genes，and the carriage of virulence genes by different ST types，populations and inpatient wards of Staphylococcus aureus shows significant differences.

Key words: Staphylococcus aureus, Virulence gene, Adhesion factor, Hemolytic toxin, Enterotoxin, Bloodstream infection

中图分类号:

R378.1

余佳佳, 刘瑛. 血流感染金黄色葡萄球菌毒力基因分布特征[J]. 检验医学, 2026, 41(8): 799-805.

YU Jiajia, LIU Ying. Distribution characteristics of virulence genes of Staphylococcus aureus causing bloodstream infections[J]. Laboratory Medicine, 2026, 41(8): 799-805.

图/表 6

参考文献 19

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ST型别	CC克隆群^①	株数/株	平均携带毒力基因数/个
398		13	7.8
59		10	8.7
88		7	9.4
1	1	6	12.7
22	22	6	12.0
6	5	5	9.6
764	5	5	10.8
188	1	4	7.8
630	8	3	10.0

ST型别	CC克隆群^①	株数/株	平均携带毒力基因数/个
398		13	7.8
59		10	8.7
88		7	9.4
1	1	6	12.7
22	22	6	12.0
6	5	5	9.6
764	5	5	10.8
188	1	4	7.8
630	8	3	10.0

项目	PVL	tst	eta	etb	hla		hlb		hlg		icaA		cna		clfA		clfB		fnbA		fnbB
总体	12.1	15.4	1.1	0	100		83.5		100.0		100.0		48.4		46.2		75.8		45.1		31.9
成人	3.3	20.0	0	0	100		86.7		100.0		100.0		48.3		38.3		68.3		53.3		35.0
儿童	29.0	6.5	3.2	0	100		77.4		100.0		100.0		48.4		61.3		90.3		29.0		25.8
χ²值	12.703	2.882					1.270						0.000		4.334		4.259		4.876		0.796
P值	<0.001	0.090	0.341				0.260						0.996		0.037		0.039		0.027		0.372
项目	sdrC	sdrD	sdrE	sea		seb		sec		sed		see		seg		seh		sei		sej
总体	69.2	62.6	76.9	18.7		16.5		18.7		4.4		0		40.7		6.6		39.6		4.4
成人	76.7	73.3	86.7	21.7		13.3		25.0		5.0		0		46.7		8.3		46.7		5.0
儿童	54.8	41.9	58.1	12.9		22.6		6.5		3.2		0		29.0		3.2		25.8		3.2
χ²值	4.572	8.601	9.420	1.033		1.270		3.489		0.000				2.634		0.235		3.720		0.000
P值	0.033	0.003	0.002	0.464		0.260		0.062		1.000				0.105		0.628		0.054		1.000

项目	PVL	tst	eta	etb	hla		hlb		hlg		icaA		cna		clfA		clfB		fnbA		fnbB
总体	12.1	15.4	1.1	0	100		83.5		100.0		100.0		48.4		46.2		75.8		45.1		31.9
成人	3.3	20.0	0	0	100		86.7		100.0		100.0		48.3		38.3		68.3		53.3		35.0
儿童	29.0	6.5	3.2	0	100		77.4		100.0		100.0		48.4		61.3		90.3		29.0		25.8
χ²值	12.703	2.882					1.270						0.000		4.334		4.259		4.876		0.796
P值	<0.001	0.090	0.341				0.260						0.996		0.037		0.039		0.027		0.372
项目	sdrC	sdrD	sdrE	sea		seb		sec		sed		see		seg		seh		sei		sej
总体	69.2	62.6	76.9	18.7		16.5		18.7		4.4		0		40.7		6.6		39.6		4.4
成人	76.7	73.3	86.7	21.7		13.3		25.0		5.0		0		46.7		8.3		46.7		5.0
儿童	54.8	41.9	58.1	12.9		22.6		6.5		3.2		0		29.0		3.2		25.8		3.2
χ²值	4.572	8.601	9.420	1.033		1.270		3.489		0.000				2.634		0.235		3.720		0.000
P值	0.033	0.003	0.002	0.464		0.260		0.062		1.000				0.105		0.628		0.054		1.000

项目	PVL	tst	eta	etb	hla		hlb		hlg		icaA		cna		clfA		clfB		fnbA		fnbB
总体	12.1	15.4	1.1	0	100.0		83.5		100.0		100.0		48.4		46.2		75.8		45.1		31.9
MRSA	6.8	27.3	0	0	100.0		88.6		100.0		100.0		27.3		40.9		59.1		54.5		29.5
MSSA	17.0	4.3	2.1	0	100.0		78.7		100.0		100.0		68.1		51.1		91.5		36.2		34.0
χ²值	1.370	7.565					1.622						15.157		0.943		11.305		3.100		0.212
P值	0.242	0.006	1.000				0.203						<0.001		0.332		<0.001		0.078		0.645
项目	sdrC	sdrD	sdrE	sea		seb		sec		sed		see		seg		seh		sei		sej
总体	69.2	62.6	76.9	18.7		16.5		18.7		4.4		0		40.7		6.6		39.6		4.4
MRSA	65.9	72.7	86.4	27.3		22.7		36.4		4.5		0		45.5		11.4		43.2		4.5
MSSA	72.3	53.2	68.1	10.6		10.6		2.1		4.3		0		36.2		2.1		36.2		4.3
χ²值	0.441	3.706	4.277	4.139		2.412		15.353		0.000				0.812		1.827		0.467		0.000
P值	0.507	0.054	0.039	0.042		0.120		<0.001		1.000				0.368		0.177		0.494		1.000