儿童社区获得性耐甲氧西林金黄色葡萄球菌皮肤软组织感染临床分离株的分子特征及耐药性研究  

Molecular characterization and antimicrobial resistance of community-associated methicillin-resistant Staphylococcus aureus strains isolated from children with skin and soft tissue infections

作　　者：孙明姣[1] 王丽娟[1] 刘颖超[1] 李向梅[1] 孙静[1] 王传清[2] 邓秋莲[3] 郑跃杰[4] 刘岚[5] 李昌崇[6] 尚云晓[7] 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,教育部儿科重大疾病研究重点实验室,北京100045 [2]复旦大学附属儿科医院 [3]广州市儿童医院 [4]深圳市儿童医院 [5]重庆医科大学附属儿童医院 [6]温州医学院附属医院 [7]沈阳盛京医院 [8]广州市妇幼保健院

出　　处：《中国感染与化疗杂志》2013年第1期19-24,共6页Chinese Journal of Infection and Chemotherapy

基　　金：国家自然科学基金国际(地区)合作与交流项目(81061160509);国家自然科学基金面上项目(81171648)

摘　　要：目的了解儿童社区获得性耐甲氧西林金葡菌(CA-MRSA)皮肤软组织感染(SSTIs)的临床分离株分子生物学特征及药物敏感性。方法收集儿科CA-MRSA SSTIs患儿60例,对CA-MRSA分离株进行多位点基因分型(MLST分型)、SC-Cmec分型及spa分型,同时检测pvl基因,并进行15种抗菌药物药敏试验。结果在60例SSTIs患儿中,脓肿25例(41.7%),脓疱疮12例(20.0%),其他23例(38.3%)。60株临床分离株共分出12种ST型,ST59 29株,占48.3%,ST88和ST1均为6株,各占10.0%;SCCmec分型共有4种,SCCmecⅣ型占55.0%(33/60),SCCmecⅤ型28.3%(17/60),SCCmecⅢ型15.0%(9/60),SCCmecⅡ型1.7%(1/60)。在21种spa基因型中,t437占46.7%。分离株pvl携带率50.0%。该菌对红霉素、克林霉素、庆大霉素、氯霉素、四环素、环丙沙星、甲氧苄胺-磺胺甲口恶唑、利福平、夫西地酸和莫匹罗星的耐药率分别是90.0%、80.0%、46.7%、38.3%、38.3%、33.3%、28.3%、11.6%、3.3%和3.3%。多重耐药率为73.3%。结论儿童SSTIs的CA-MRSA临床分离株最常见的克隆是MRSA-ST59-SCCmecIVa-t437和MRSA-ST59-SCCmecV-t437,多重耐药率高,在儿童CA-MRSA SSTIs的经验性治疗中不宜首选红霉素和克林霉素。Objective The present study aimed to investigate the molecular characteristics and antimicrobial susceptibility of community associated methicillin-resistant Staphylococcus aureus （CA-MRSA） isolates from children with skin and soft tissue infections （SSTIs）. Methods A total of 60 CA-MRSA isolates were collected from children with SSTIs. The clini- cal data were recorded. The multilocus sequence typing （MLST） and staphylococcal cassette chromosome mec （SCCmec） types were analyzed by multiplex polymerase chain reaction （PCR）. The spa type was also analyzed by PCR. The Panton-Valentine leukocidin （PVL） gene was de- tected. The antimicrobial susceptibility was determined with 15 antibiotics. Results Among the 60 SSTI cases, the mostcommon form of the disease was abscess （n = 25, 41.7% ）, followed by impetigo （n = 12, 20%）. Twelve ST types were identi- fied. The most common type was ST59 （n = 29, 48.3%）, followed by ST88 and ST1 （6 each, 10.0 % ）. Four SCCmec types were found. The most common type was SCCmecIg （55.0%, 33/60）, followed by SCCmecV （28.3%, 17/60）, SCCmecⅢ （15. 0%, 9/60）, and SCCmeeⅡ （1.7%, 1/60）. Among the 21 spa types, the most common was t437 （46.7%）. The preva lence of PVL was 50% in the CA-MRSA strains tested. The percentage of the CA-MRSA strains resistant to erythromycin, clindamycin, gentamycin, chloramphenicol, tetracycline, ciprofloxacin, trimethoprim-sulfamethoxazole, rifampin, fusidic acid, and mupirocin was 90.0%, 80.0%, 46.7% , 38.3%, 38.3%, 33.3%, 28.3% , li.6%, 3.3%, and 3.3%, respectively. The prevalence of muhidrug resistant strains was 73.3 %. Conclusions The most frequently isolated bacterial clones were MR SA-ST59-SCCmeclVa-t437 and MRSA ST59-SCCmecV t437 in the children with SSTIs caused by CA MRSA. The multidrug resistant strain was highly prevalent. Erythromycin and clindamycin should not be preferred in empiric treatment of children with community-acquired SSTls.

关 键 词：社区获得性耐甲氧西林金黄色葡萄球菌 皮肤软组织感染 细菌分型技术 抗生素敏感性 

分 类 号：R446.5[医药卫生—诊断学]