葡萄球菌性烫伤样皮肤综合征的致病金黄色葡萄球菌剥脱毒素基因型及耐药研究  

Exfoliative toxin serotype genes and antibiotic resistance of staphylococcus aureus isolated from children with staphylococcal scalded skin syndrome

作　　者：苏怡帆[2] 王华[1] 肖异珠[1] 欧阳莹[1] 李咏梅[1] 罗晓燕[1] 谭琦[1] 向娟[1] 

机构地区：[1]重庆医科大学儿童医院皮肤科,400014 [2]成都市第二人民医院

出　　处：《中华皮肤科杂志》2008年第11期711-713,共3页Chinese Journal of Dermatology

摘　　要：目的探讨葡萄球菌性烫伤样皮肤综合征（SSSS）致病的金黄色葡萄球菌（简称金葡菌）分泌表皮剥脱毒素（ET）的主要类型及耐药情况。方法108株金葡菌分离自SSSS（36例）、脓疱疮（36例）及皮肤脓肿（36例）。用多重PCR法测定致病金葡菌菌株产ETA、ETB、ETD基因型，Kirby—Bauer纸片法检测其对20种抗生素的敏感性。结果36株来源于SSSS的金葡菌100％（36／36）为产ET菌株，其中单产ETA2株（6％），ETB7株（19％），兼产ETA和ETB27株（75％）。来源于脓疱疮的36株金葡菌78％（28，36）为产ET菌株，单产ETA5株（14％），兼产ETA和ETB23株（64％），未发现单产ETB金葡菌。而分离自皮肤脓肿的36株金葡菌仅2．8％（1／36）产ET，为兼产ETA和ETB菌株。108株金葡菌均未检测到ETD。金葡菌产ET的型别分布在三组疾病间差异有统计学意义（r=89．4，P〈0．01），且分离自SSSS的金葡菌株产ET的比例明显高于脓疱疮组（r=9．0，P〈0．01）和脓肿组（r=68．1，P〈0．01）。三组病例的致病金葡菌对青霉素、氨苄西林、大环内酯类及克林霉素高度耐药，但对头孢类抗生素均敏感。脓肿组发现2例耐甲氧西林金葡菌株（MRSA）。结论SSSS及脓疱疮患儿的致病金葡菌主要为产ET菌株，并以兼产ETA和ETB菌株为主。Objective To investigate the exfoliative toxin serotype genes and antibiotic resistance of Staphylococcus aureus （SA） isolated from children with staphylococcal scalded skin syndrome （SSSS）. Methods In total, 108 strains of SA were isolated from 36 patients with SSSS, 36 patients with impetigo and 36 patients with abscess. Multiplex PCR was used to detect the staphylococcal exfoliative toxin A, B and D genes, Kirby-Bauer method to test the susceptibilities of SA strains to 20 antibiotics. Results All the 36 SA isolates from SSSS patients were ET-positive, and 2 （6%） produced ETA, 7 （19%） ETB, 27 （75%） both ETA and ETB; of the 36 isolates from patients with impetigo, 78% produced ET, and 14% produced ETA, 64% produced both ETA and ETB, while no single ETB-producing strain was found; ET was detected in only one （2.8%） SA isolate from abscess patients, which produced both ETA and ETB. ETD was detected in none of the SA isolates. There was a statistical difference in the distribution of ET serotype among the three diseases （x^2 = 89.4, P 〈 0.01 ） and the proportion of ET-producing strains in SSSS group was significantly higher than that in impetigo group （x^2 = 9.0, P 〈 0.01 ） and abscess group （X^2 = 68.1, P 〈 0.01 ）. All the SA isolates were highly resistant to penicilin, ampicillin, macrolides and clindamycin, but sensitive to other 15 common antibiotics such as cephalosporin. Two strains of MRSA were found in patients with abscess. Conclusion In Chongqing, ET-producing SA is the common pathogenic bacteria of SSSS and impetigo, and most of SA strains produce both ETA and ETB.

关 键 词：葡萄球菌 金黄色 葡萄球菌烧灼性皮肤综合征 黄水疮 脱叶素类 

分 类 号：R753[医药卫生—皮肤病学与性病学] R378.11[医药卫生—临床医学]