金黄色葡萄球菌pvl基因检测与分布研究
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摘要
目的探讨临床分离的金黄色葡萄球菌杀白细胞毒素(PVL)基因携带及各种类型菌株的分布情况,为医院感染管理及监测提供病原学依据。方法对2017年1月-2017年12月汉川市人民医院的193株金黄色葡萄球菌临床标本进行头孢西丁纸片法、聚合酶链式反应(PCR)扩增法mecA及pvl基因检测。依照美国临床与实验室标准协会(CLSI)2017版的推荐标准进行结果判读。结果 193株金黄色葡萄球菌菌株中分离出耐甲氧西林金黄色葡萄球菌(MRSA)62株,占32.1%;pvl基因检测阳性菌株29株,占15.0%,其中MSSA 21株占16.0%,MRSA 8株占12.9%,检验结果显示差异无统计学意义(χ2=0.332,P=0.570);pvl阳性MRSA中CA-MRSA 6株,HA-MRSA 2株,分别占37.5%、4.3%,检验结果显示差异有统计学意义(χ2=11.609,P=0.001)。结论金黄色葡萄球菌pvl基因检测对于临床治疗及预后判断有积极的作用,对携带pvl基因菌株数量及分布情况的监测是针对金黄色葡萄球菌实施精准化感控的必要手段。
OBJECTIVE To investigate the distribution of leucocytic toxin gene(PVL)in various strains of Staphylococcus aureus isolated from clinical specimens,so as to provide the etiological basis for nosocomial infection management and monitoring.METHODS The cefoxitin disk method and polymerase chain reaction(PCR)method were used to detect mecAand pvl genes in the 193 strains of S aureus from clinical specimens in Hanchuan People's Hospital from Jan.2017 to Dec.2017.The results were interpreted according to the recommended criteria of CLSI(2017 version).RESULTS From the 193 strains of S aureus,62 strains of methicillin-resistant S aureus(MRSA)were isolated,accounting for 32.1%.There were 29 pvl-positive strains,accounting for 15%,of which 21 were MSSA,accounting for 16%(21/131)of all MSSA strains,and the other 8 strains were MRSA,accounting for12.9%(8/62)of all MRSA strains.The chi square test results showed that the difference was not significant(χ2=0.332,P=0.570).There were 6 strains of CA-MRSA and 2 strains of HA-MRSA in pvl-positive MRSA,accounting for 37.5%and 4.3%,and the difference was significant(χ2=11.609,P=0.001).CONCLUSIONThe detection of pvl gene in S aureus has a positive effect on clinical treatment and prognosis.The monitoring of the number and distribution of pvl gene is a necessary means for precise control of S aureus.
OBJECTIVE To investigate the distribution of leucocytic toxin gene(PVL)in various strains of Staphylococcus aureus isolated from clinical specimens,so as to provide the etiological basis for nosocomial infection management and monitoring.METHODS The cefoxitin disk method and polymerase chain reaction(PCR)method were used to detect mecAand pvl genes in the 193 strains of S aureus from clinical specimens in Hanchuan People's Hospital from Jan.2017 to Dec.2017.The results were interpreted according to the recommended criteria of CLSI(2017 version).RESULTS From the 193 strains of S aureus,62 strains of methicillin-resistant S aureus(MRSA)were isolated,accounting for 32.1%.There were 29 pvl-positive strains,accounting for 15%,of which 21 were MSSA,accounting for 16%(21/131)of all MSSA strains,and the other 8 strains were MRSA,accounting for12.9%(8/62)of all MRSA strains.The chi square test results showed that the difference was not significant(χ2=0.332,P=0.570).There were 6 strains of CA-MRSA and 2 strains of HA-MRSA in pvl-positive MRSA,accounting for 37.5%and 4.3%,and the difference was significant(χ2=11.609,P=0.001).CONCLUSIONThe detection of pvl gene in S aureus has a positive effect on clinical treatment and prognosis.The monitoring of the number and distribution of pvl gene is a necessary means for precise control of S aureus.
引文
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[14]刘玉枝,王凤玲,陈洋,等.金黄色葡萄球菌致病毒素基因与耐药性的相关性研究[J].检验医学与临床,2012,9(17):2151-2153.
[15]王敏.耐甲氧西林金黄色葡萄球菌分子流行病学及临床感染特征的研究[D].中国人民解放军军事医学科学院,2017.
[2]Seidl K,Leimer N,Palheiros Marques M,et al.Zinkernagel.USA300methicillin-resistant Staphylococcusaureusin Zurich,Switzerland between 2001and 2013[J].Int J Med Microbiol,2014,304(8):1118-1122.
[3]国家卫生计生委员会.医院感染管理质量控制指标[Z].2015-03-31.
[4]李亚茹,刘一阳,贾丹丹,陈代杰.耐甲氧西林金葡菌致病因子研究进展[J].世界临床药物,2015,36(07):442-446.
[5]虞亦鸣.医院内MRSA感染危险因素分析及毒力、耐药基因检测[D].苏州大学,2016.
[6]国家药典委员会.中华人民共和国药典[M].2015版第四部.北京:中国医药科技出版社,2015:204-228.
[7]陈宏斌,王辉.2017年CLSI M100-S27主要更新内容解读[J].中华检验医学杂志,2017,40(4):238-241.
[8]崔兰卿,李耘,薛峰,张佳,吕媛.苯唑西林敏感甲氧西林耐药金黄色葡萄球菌的分子流行病学及耐药性分析[J].中国临床药理学杂志,2015,31(11):912-915.
[9]Sherlock O,Dolan A,Humphreys H.MRSA screening:can one swab be used for both culture and rapid testing?An evaluation of chromogenic culture and subsequent Hain GenoQuick PCR amplification/detection[J].Clin Microbiol Infect,2010,16(7):955-959.
[10]沈利蒙,张易进,孔江英,等.耐甲氧西林金黄色葡萄球菌pvl及tst基因分布与感染类型研究[J].中华医院感染学杂志,2016,26(10):2186-2189.
[11]曾云祥,林高贵,梁世周,等.携带杀白细胞素基因金黄色葡萄球菌临床感染菌株的回顾性研究[J].中华医院感染学杂志,2017,27(2):276-279,291.
[12]陈怡丽,罗敏,郭鹏豪,等.mecA基因与耐甲氧西林金黄色葡萄球菌感染临床特点的相关性研究[J].中国卫生检验杂志,2017,27(3):436-440.
[13]刘潇,陈锋,朱震宏,等.新疆乌鲁木齐地区pvl阳性耐甲氧西林金黄色葡萄球菌耐药性检测[J].新疆医科大学学报,2013,36(3):330-333.
[14]刘玉枝,王凤玲,陈洋,等.金黄色葡萄球菌致病毒素基因与耐药性的相关性研究[J].检验医学与临床,2012,9(17):2151-2153.
[15]王敏.耐甲氧西林金黄色葡萄球菌分子流行病学及临床感染特征的研究[D].中国人民解放军军事医学科学院,2017.