中国七城市儿童耐甲氧西林金黄色葡萄球菌感染分离株分子学特征的研究  

Molecular characteristics of methicillin resistant Staphylococcus aureus isolated from Chinese children

作　　者：刘颖超[1] 耿文静[1] 吴德静[1] 李向梅[1] 王传清[2] 陆权[3] 邓秋莲[4] 郑跃杰[5] 刘岚[6] 李昌崇[7] 尚云晓[8] 赵长安 杨永弘[1] 沈叙庄[1] 

机构地区：[1]首都医科大学附属北京儿童医院北京市儿科研究所,儿科学国家重点学科省部共建儿科重大疾病研究重点实验室,100045 [2]复旦大学附属儿科医院新生儿科 [3]上海交通大学附属儿童医院呼吸科 [4]广州市儿童医院检验科 [5]深圳市儿童医院呼吸科 [6]重庆医科大学附属儿童医院检验科 [7]温州医学院附属第二医院育英儿童医院 [8]中国医科大学附属盛京医院小儿内科 [9]广州妇幼保健院儿科

出　　处：《中华儿科杂志》2012年第1期38-44,共7页Chinese Journal of Pediatrics

基　　金：国家自然科学基金（30872789）;国家自然科学基金委员会与香港研究资助局联合科研基金项目（81061160509）;北京市自然科学基金（7092030）

摘　　要：目的探讨我国7个城市儿童耐甲氧西林的金黄色葡萄球菌（MRSA）感染分离株的分子特征。方法收集2005至2009年全国7个城市（北京、上海、深圳、广州、温州、沈阳、重庆）9所三级儿童医院分离的134株MRSA。采用PCR和测序对MRSA进行多位点序列分型（MLST）和spa分型，采用多重PCR进行SCCmec分型，同时检测pvl基因。结果MRSA大多数来源于肺炎和皮肤软组织感染分离株，占82．1％；共检测到16个MLST型，最主要的sT型是ST59（44．8％），其次是ST239（16．4％）；SCCmec分型共有Ⅱ、Ⅲ、Ⅳ和V型4型，其中Ⅳ型是最常见的SCCmec型（50．0％），其次是V型（23．9％）和Ⅲ型（23．9％），Ⅳ型中最常见的亚型是Ⅳa（77．6％）；检测到26种spa分型，最重要的spa型是t437（47．8％）；菌株的pvl携带率与菌株SCCmec分型有关，SCCmecⅣ和Ⅴ型菌株的pvl携带率大于Ⅱ和Ⅲ型（58．6％vs．14．3％，P〈0．05），且差异有统计学意义。不同疾病来源和不同地区来源的菌株，其流行克隆不同。结论2005至2009年我国儿童MRSA感染分离株的流行克隆为ST59-MRSA—IVa（t437）和ST239．MRSA—m（t037），可能分别属于社区获得性MRSA与医院获得性MRSA。因此，开展对于MRSA临床流行病学监测和分子生物学的研究十分必要，能够为制定本地区防治措施提供循证依据，从而有效降低MRSA在社区和医院内的发病。Objective To investigate the molecular characteristics of methicillin-resistant Staphylococcus aureus （MRSA） isolates from Chinese children in seven cities. Method A total of 134 MRSA isolates were collected from nine hospitals. Multilocus sequence typing and spa typing were analyzed by polymerase chain reaction （ PCR）, and staphylococcal chromosomal cassette mec （SCCmec） type was analyzed by multiplex PCR. The Panton-Valentine leukocidin （pvl） gene was also detected. Result Most MRSA strains were isolated from pneumonia and skin and soft tissue infection （SSTIs） patients, accounting for 82. 1%. Overall, 16 sequence types （STs） were obtained, and CC59 （51.7%） was found to be the most prevalent, which included ST 59 and ST 338, followed by ST239 （ 16. 4% ）. SCCmec types Ⅱ、Ⅲ、Ⅳ and V were also identified in the current study. SCCmec type Ⅳ was the most predominant type at 50. 0% , followed by SCCmec type V at 23.9% and m at 23.9%. SCCmec subtypes IVa, 1gc, and Ivg were found among SCCmec type 1V strains, whereas Ⅳa was the main subtype at 77. 6%. Twenty-six spa types were also identified, among which the predominant type was t437 （47.8%）. The prevalence of pvl genes and the SCCmec type of strain was relevant, and the pvl gene positive rate was higher in SCCmec type Ⅳ and V-type strains than in SCCmec type Ⅱ and m strains （58.6% vs. 14. 3% , P 〈0. 05） ; there was a significant difference between them. In the strains isolated from pneumonia and SSTIs, ST59-MRSA-IVa （t437） was the predominant clone. There were five clones detected from the strains isolated from septicemia, with ST59-MRSA-IV a （ t437 ） and ST59-MRSA-V （ t437 ） as the main clones （ 57. 1% ） . Various predominant clones existed in different regions. ST59-MRSA-IVa（t437） was the prevalent clone in the Guangzhou, Beijing, Chongqing, and Shenzhen areas, whereas ST239-MRSA-m （t037）was the prevalent clone in the Shanghai area. Fifty percent of the isolates from the Wenzhou area

关 键 词：葡萄球菌 金黄色 甲氧西林抗药性 细菌分型技术 

分 类 号：R446.5[医药卫生—诊断学]