武汉地区门诊皮肤软组织感染患者中甲氧西林敏感金黄色葡萄球菌PVL基因携带及耐药性检测

摘要/Abstract

摘要： 目的探讨从武汉地区门诊皮肤软组织感染（SSTI）患者中分离的甲氧西林敏感金黄色葡萄球菌（MSSA）携带杀白细胞毒素（PVL）基因及耐药特征。方法收集2011—2013年在武汉市5所医疗机构门诊就诊SSTI患者中分离的182株MSSA，采用纸片扩散法进行药敏试验，多重PCR法检测mecA基因和PVL基因。结果 182株MSSA中有65株PVL阳性，阳性率为35.71%。不同病种PVL阳性率差异有统计学意义（χ2 = 49.76，P = 0.00），其中疖/痈（7/7）、毛囊炎（3/3）、脓肿（55.53%，30/57）和脓疱疮（2/4）的检出率较高。PVL阳性患者年龄［（35.40 ± 19.31）岁］小于PVL阴性患者［（43.21 ± 20.75）岁］，差异有统计学意义（t = 2.50，P = 0.01）。在65株PVL阳性MSSA菌株中，耐药率居前3位的依次是氨苄西林（87.69%）、青霉素（53.85%）、红霉素（41.54%）。在117株PVL阴性MSSA菌株中，耐药率居前3位的依次是克林霉素（26.50%）、青霉素（20.51%）、氨苄西林（12.82%）。PVL阳性MSSA菌株对青霉素（χ2 = 21.19）、氨苄西林（χ2 = 97.97）、多西环素（χ2 = 11.61）、环丙沙星（χ2 = 8.07）、红霉素（χ2 = 25.04）、庆大霉素（χ2 = 10.86）的耐药率高于PVL阴性MSSA菌株，差异均有统计学意义（P < 0.05）。结论武汉地区门诊MSSA SSTI患者中，PVL阳性率较高，对大多数β内酰胺类抗菌药物耐药，经验治疗可选择氟氯西林、复方磺胺甲恶唑片或多西环素。

Abstract: Liu Xiaoli, Wang Bin, Jiang Yuanshan, Liang Jiansheng, Yuan Hong, Zhang Lihua, Zhou Yanfei, Xu Huiqiong Department of Disinfection and Pest Control, Wuhan Centers For Disease Prevention and Control, Wuhan 430015, China （Liu XL, Wang B, Liang JS, Xu HQ）; Institute of Pathogen Detection, Wuhan Centers For Disease Prevention and Control, Wuhan 430015, China （Jiang YS）; Department of Nursing, Wuhan No. 1 Hospital, Wuhan 430022, China （Yuan H）; Department of Hospital Infection Management, Huangpi People′s Hospital, Wuhan 430300, China （Zhang LH）; Department of Hospital Infection Management, Wuhan Fifth Hospital , Wuhan 430050, China （Zhou YF） Corresponding author: Liang Jiansheng, Email: wh-ljs@sohu.com 【Abstract】 Objective To estimate the prevalence of Panton-Valentine leukocidin （PVL） genes and antimicrobial resistance in methicillin-sensitive Staphylococcus aureus （MSSA） isolateds from outpatients with skin and soft-tissue infections （SSTIs） in Wuhan city. Methods A total of 182 MSSA isolates were collected from outpatients with SSTIs in 5 different hospitals in Wuhan city between 2011 and 2013. The Kirby-Bauer′s disk diffusion method was used to evaluate antimicrobial susceptibility of the MSSA isolates, and multiplex PCR was performed to detect mecA and PVL genes in these isolates. Results Of the 182 MSSA isolates, 65 （35.71%） carried PVL genes. The positive rate of PVL genes was significantly different among patients with different diseases （χ2 = 49.76, P = 0.00）, and relatively higher in patients with furuncles/carbuncles （7/7）, folliculitis （3/3）, abscesses （55.53%, 30/57） or impetigo （2/4）. The age of patients with PVL-positive MSSA infection was significantly younger than that with PVL-negative MSSA infection （35.40 ± 19.31 years vs. 43.21 ± 20.75 years, t = 2.50, P = 0.01）. Among 65 PVL-positive MSSA isolates, the rate of resistance to clindamycin was highest （87.69%）, followed by that to penicillin （53.85%） and erythromycin （41.54%）. The frequency of resistance to clindamycin was highest in 117 PVL-negative MSSA isolates, followed by that to penicillin （20.51%） and ampicillin （12.82%）. Furthermore, there was a significant increase in the rate of resistance to penicillin （χ2 = 21.19）, ampicillin （χ2 = 97.97）, doxycycline （χ2 = 11.61）, ciprofloxacin （χ2 = 8.07）, erythromycin （χ2 = 25.04） and gentamicin （χ2 = 10.86） in PVL-positive MSSA isolates compared with PVL-negative MSSA isolates （all P < 0.05）. Conclusions MSSA isolates from outpatients with SSTIs in Wuhan city are resistant to most β-lactam antibiotics. Flucloxacillin, compound sulfamethoxazole tablets or doxycycline is recommended for empirical treatment of PVL-positive MSSA infections.

刘小丽王斌江元山梁建生袁红张丽华周燕飞许慧琼. 武汉地区门诊皮肤软组织感染患者中甲氧西林敏感金黄色葡萄球菌PVL基因携带及耐药性检测[J]. 中华皮肤科杂志, 2016, 49(3): 172-175.doi:

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