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目的分析医院冠状动脉介入治疗患者感染耐甲氧西林金黄色葡萄球菌(MRSA)流行特点及其毒力基因分布情况,为预防冠状动脉介入治疗患者感染发生及控制病原菌扩散提供指导。方法收集医院冠状动脉介入治疗患者的送检标本,从中分离MRSA,鉴定并剔除重复菌株。采用K-B法分析MRSA菌株对苯唑西林等5种常用抗生素的耐药情况,根据2015年CLSI标准判定结果,采用PCR扩增检测MRSA菌株的毒力基因分布情况。结果共分离164株MRSA,其中85株分离自痰液标本,占51.83%;34株分离自脓液标本,占20.73%;26株分离自血液标本,占15.85%;7株分离自穿刺液标本,占4.27%;12株分离自其他标本,占7.32%。MRSA分离株对5种常用抗菌药物的耐药程度从高到低依次为苯唑西林、头孢曲松、亚胺培南、环丙沙星、万古霉素,耐药率依次为100.00%、87.20%、51.22%、43.90%和0。PCR扩增MRSA菌株pvl基因为939bp,fnbA基因为642bp,clfA基因为292bp。130株MRSA菌株检出pvl基因,阳性率为79.27%;103株检出fnbA基因,阳性率为62.80%;67株检出clfA基因,阳性率为40.85%。结论在冠状动脉介入治疗患者MRSA主要分布于痰液中,治疗用药优先考虑万古霉素,其致病性可能与其毒力基因分布有关。
Objective To analyze the epidemiological characteristics and virulence gene distribution of methicillin-resistant Staphylococcus aureus (MRSA) in patients undergoing coronary artery interventional treatment in hospital and provide guidance for preventing the occurrence of infection and controlling the spread of pathogens in patients undergoing coronary intervention. Methods The specimens of patients undergoing coronary intervention in hospitals were collected and MRSA was isolated from them. The duplicate strains were identified and eliminated. The K-B method was used to analyze the resistance of MRSA strains to five commonly used antibiotics such as oxacillin. According to the CLSI criteria of 2015, the virulence gene distribution of MRSA strains was detected by PCR amplification. Results A total of 164 strains of MRSA were isolated, of which 85 were isolated from sputum samples, accounting for 51.83%. 34 were isolated from pus samples accounting for 20.73%, 26 were isolated from blood samples accounting for 15.85%, 7 were isolated from puncture fluid specimens , Accounting for 4.27%; 12 strains isolated from other specimens, accounting for 7.32%. The resistance of MRSA isolates to oxacillin, ceftriaxone, imipenem, ciprofloxacin and vancomycin in descending order of resistance to five commonly used antibiotics was 100.00% and 87.20, respectively. %, 51.22%, 43.90% and 0. The PCR amplified MRSA strain pvl gene was 939bp, fnbA gene was 642bp, clfA gene was 292bp. 130 strains of MRSA were detected pvl gene, the positive rate was 79.27%; 103 strains were detected fnbA gene, the positive rate was 62.80%; 67 strains were detected clfA gene, the positive rate was 40.85%. Conclusions MRSA is mainly distributed in sputum in patients undergoing coronary intervention, and vancomycin is the preferred drug for treatment. The pathogenicity may be related to its virulence gene distribution.