新生儿侵袭性社区获得性金黄色葡萄球菌感染的临床及分离株的分子特征  

Clinical and molecular characteristics of invasive community - associated Staphylococcus aureus infections in Chinese neonates

作　　者：李文婷[1] 董燕红[1] 宁雪[1] 曾婷[1] 俞桑洁[1] 姚开虎[1] 史伟[1] 高薇[1] 袁琳[1] 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,教育部儿科重大疾病研究重点实验室,国家呼吸系统疾病临床医学研究中心,儿童呼吸道感染性疾病研究北京市重点实验室,100045

出　　处：《中华实用儿科临床杂志》2015年第22期1692-1696,共5页Chinese Journal of Applied Clinical Pediatrics

基　　金：国家自然科学基金（81171648,81061160509）

摘　　要：目的了解新生儿侵袭性社区获得性金黄色葡萄球菌（CA-SA）感染的临床及分子特征。方法收集国内3所儿童医院侵袭性CA—SA感染新生儿56例并进行分析，对分离株行多位点基因分型（MLST）、SCCmec及spa分型，检测pvl基因并进行体外药物敏感试验。结果56例侵袭性CA—SA感染的新生儿中，甲氧西林敏感金黄色葡萄球菌（MSSA）感染37例（66．07％），耐甲氧西林金黄色葡萄球菌（MRSA）感染19例（33．93％）；晚发型感染48例（85．71％），16例（28．57％）需入住重症监护病房（ICU）。最常见诊断：肺炎41例（73．20％），脓毒症33例（58．93％）。MSSA组脓毒症比例（70．27％，26／37例）显著高于MRSA组（36．84％，7／19例）（P=0．016）。43例（76．79％）患儿存在多部位感染，21例（37．50％）患儿有并发症，2例患儿死亡。45例患儿（80．36％）联合使用抗生素，MRSA组使用万古霉素的比例（52．63％，10／19例）明显高于MSSA组（16．22％，6／37例）（P=0．004）；22例（39．29％）患儿接受外科干预治疗。分离株共检测到16种ST型，ST59最常见（19株，33．93％），5种SCCmec型以Ⅳ型（10株，52．63％）为主，Ⅳ亚型主要为Ⅳa（9／10株），有25种spa型，t437（17株，30．36％）为主，13株（23．21％）检测到pvl基因。各ST型在疾病谱分布上差异均无统计学意义（P均〉0．05），多重耐药率为42．86％。结论新生儿侵袭性CA—SA感染多见于重症、晚发型，以肺炎和脓毒症为主，MSSA组发生脓毒症比例高于MRSA组，多部位感染多见，联合用药和外科干预率高。分离株最常见克隆为ST59-t437，不同分型分离株感染在疾病谱上无明显差别。Objective To investigate the clinical and molecular features of invasive community - associated Staphylococcus aureus（ CA - SA） infection in Chinese neonates. Methods Fifty - six invasive CA - SA strains were collected from 3 Chinese Children＇s Hospitals. Isolates were analyzed by multi -locus sequence typing （MLST） , SCC- mec,spa typing and antimicrobial susceptibility, followed by expression analysis for pvl. Results Among 56 invasive CA - SA infection cases, 37 cases （ 66.07 % ） suffered from methicillin - susceptible Staphylococcus aureus （MSSA） infection, 19 cases （33.93%） manifested methicillin - resistant Staphylococcus aureus （MRSA） ,48 cases （ 85.71% ） belonged to late -onset type, and 16 cases （28.57%） were admitted to intensive care unit （ICU）. Pneumonia （41 cases,73.20% ） and septicemia（33 cases,58.93% ） were the most common infections. The proportion of septicemia caused by MSSA （70.27%, 26/37 ） cases was significantly higher than that of MRSA （ 36.84%, 7/19 cases） （ P = 0. 016） ;43 cases （76.79%） showed two or more infection sites,complications were found in 21 patients （37.50%） , and 2 cases died. The percentage of antibiotic combination was 80.36% （45 cases）. Up to 52. 63% （ 10 cases） were treated with vancomycin in MRSA group,which were more than those of MSSA group （16.22% ,6/37 cases） ,and 22 cases （39. 29% ） received surgical treatment. Sixteen sequence types were detected and the most frequent types were ST59 ; （19 strains,33.93% ）. Among 5 SCCmec types,the most common one was Ⅳ （52.63% , 10/19 cases） , IVa accounted for 9/10 strains;25 spa types were found, and the most common was t437 （17 strains, 30.36% ）;13 strains （23.21%） of isolates were pvlpositive. No differences were observed in infections among the various STs（ all P 〉 0. 05 ）. The multidrug resistance was 42.86%. Conclusions Invasive CA - SA infections in neonates were severe and more likely to be late - onset type. Pneumonia

关 键 词：婴儿 新生 社区获得性耐甲氧西林金黄色葡萄球菌 侵袭性感染 耐药 

分 类 号：R722.1[医药卫生—儿科] R446.5[医药卫生—临床医学]