儿童耐甲氧西林金黄色葡萄球菌感染临床及分子学特征研究  

Clinical features and molecular characteristics of methicillin-resistant Staphylococcus aureus in children

作　　者：吴霞[1] 王传清[2] 严秀峰[1] 王爱敏[2] 何磊燕[2] 糜祖煌[3] 俞蕙[1] 

机构地区：[1]复旦大学附属儿科医院感染传染科,上海201102 [2]复旦大学附属儿科医院细菌室,上海201102 [3]无锡市克隆遗传技术研究所

出　　处：《中华儿科杂志》2013年第7期512-517,共6页Chinese Journal of Pediatrics

摘　　要：目的 探讨儿童耐甲氧西林金黄色葡萄球菌（MRSA）感染临床及分子学特征.方法 采用队列研究方法,对复旦大学附属儿科医院2009年3月至2011年11月因MRSA感染住院患儿的临床特征进行分析；采用聚合酶链式反应（PCR）检测mecA、杀白细胞素（PVL）基因在MRSA菌株中的分布情况；多重PCR法检测MRSA SCCmec分型.结果 （1）37株MRSA中,21株来源于医院（HA-MRSA）,16株来源于社区（CA-MRSA）.MRSA感染以呼吸道感染最常见,分布以重症监护病房最多.（2）CA-MRSA感染可引起皮肤软组织感染、化脓性扁桃体炎等,严重者亦可引起肺炎、败血症等,而HA-MRSA感染更具侵袭性,其多引起肺炎、败血症,亦可引起脑膜炎.MRSA感染所致发热患儿中,与CA-MRSA感染者热程（4 d）相比,HA-MRSA感染者表现出更长的热程（10.5 d）,HA-MRSA感染患儿C反应蛋白（63.00 mg/L）较CA-MRSA（9.50 mg/L）高,差异有统计学意义（t=2.5670,P＜0.05）.白细胞计数、降钙素原差异无统计学意义.（3）37株MRSA中,mecA基因的检出率为100％.SCCmec分型以SCCmecⅢ型最多见,共17株,其次是SCCmecⅣ型8株,SCCmecⅡ型1株,未分型11株,未发现SCCmec Ⅰ、V型.其中,在21株HA-MRSA中,SCCmecⅢ型最多见,为15株,SCCmecⅣ型1株,未分型者5株；在16株CA-MRSA中,SCCmecⅣ型最多见,为7株,Ⅲ型2株,Ⅱ型1株,未分型者6株.（4）37株MRSA中,PVL基因阳性28株,在HA-MRSA中为17株（81％）,在CA-MRSA中为11株（69％）,两者检出率差异无统计学意义（x2=0.735,P＞0.05）.结论 HA-MRSA与CA-MRSA相比,其感染更具侵袭性,所致炎性指标（C反应蛋白）更高；CA-MRSA主要为SCCmecⅣ型,而HA-MRSA主要为SCCmecⅢ型；PVL毒力基因检出率高.Objective To study the clinical and molecular characteristics of methicillin-resistant Staphylococcus aureus （MRSA） infection in children.Method A total of 37 MRSA strains were isolated from hospitalized patients in Children＇s Hospital of Fudan University from March 2009 to November 2011.The clinical characteristics were investigated by a cohort study.Furthermore,the mecA,Panton-Valentine leucocidin （PVL） genes were detected by polymerase chain reaction （PCR）,and the genotypes of SCCmec were determined by multiplex PCR.Result （1） Among the 37 MRSA isolates,infections with 21 were acquired from hospital （HA-MRSA）,and 16 isolates were acquired from community （CA-MRSA）.（2） In the study,MRSA frequently caused respiratory tract iffection,and most of the strains were isolated from intensive care unit （ICU）.（3） CA-MRSA was most frequently associated with skin and soft tissue infections （SSTI）,suppurative tonsillitis,even pneumonia and septicemia.HA-MRSA infection was more aggressive,most frequently associated with pneumonia,septicemia,and central nervous system （CNS） infections,such as meningitis.In children with fever caused by HA-MRSA or CA-MRSA infection,HA-MRSA showed a longer duration of fever,for 10.5 days.C-reactive protein （CRP） level caused by HA-MRSA （63.00 mg/L） was higher than CA-MRSA（9.50 mg/L）,and there were statistically significant differences between the groups（t =2.5670,P 〈 0.05）.However,there were no statistically significant differences between the groups in white blood cell count （WBC） or procalcitonin （PCT） level.（4） Among 37 MRSA isolates,the whole isolates were mecA gene positive （100%）.SCCmec genotyping results showed that the most frequent SCCmec types were type Ⅲ,17 isolates,the others including type Ⅳ 8 isolates,type Ⅱ 1 isolates,nontypable 11 isolates,type Ⅰ and type V were not found in this group.Therein,among 21 HA-MRSA isolates,SCCmec Ⅲ was the most common,15 isolates,type Ⅳ 1 isolates,nontypable 5

关 键 词：抗甲氧西林金黄色葡萄球菌 分子生物学 临床特征 儿童 

分 类 号：R725.1[医药卫生—儿科]