儿童耐甲氧西林金黄色葡萄球菌肺炎临床分离株分析  

Clinical methicillin-resistant Staphylococcus aureus isolates from children

作　　者：乔艳红 李娟[2] 李士朋[3] 郭素梅[1] 王秋月 杨薇 沈叙庄[3] 

机构地区：[1]航空总医院儿科,北京100012 [2]济南市中心医院儿科,山东济南250013 [3]北京儿童医院风湿免疫科,北京100045

出　　处：《中华医院感染学杂志》2016年第9期2139-2142,共4页Chinese Journal of Nosocomiology

基　　金：国家自然科学基金国际(地区)合作与交流资助项目(81061160509);首都医科大学重点实验室开放基金资助项目(2015EKZD02)

摘　　要：目的探讨儿童耐甲氧西林金黄色葡萄球菌(MRSA)肺炎临床分离株的分子分型特征、pvl基因携带及耐药性特点,为临床监控及治疗提供参考。方法收集2010-2015年4所医院MRSA肺炎住院患儿的临床资料和临床分离株共52株,分析其临床特点,对MRSA进行MLST、spa、SCCmec和agr分型;PCR方法检测分离株的pvl毒力基因;采用琼脂稀释法进行抗菌药物的体外药敏试验。结果 52例MRSA肺炎患儿中21例出现脓胸占40.5%,10例出现呼吸衰竭占19.2%,6例为坏死性肺炎占11.5%,21例同时合并肺外部位的感染占40.4%,5例患儿死亡,病死率9.6%;11种MLST型中ST59最常见占50.0%,其次为ST239占25.0%;SCCmec型中SCCmecⅣ占59.6%,SCCmecⅢ占28.8%;3种agr型中Ⅰ型占84.6%;ST59-SCCmec IV-t437型为主要流行克隆占44.2%;18株携带pvl基因占34.6%,主要存在于ST59型菌株中;pvl基因在坏死性肺炎分离株中的携带率明显高于非坏死性肺炎分离株(P<0.05);所有菌株的多药耐药率为55.8%,对万古霉素、利奈唑胺、夫西地酸均敏感。结论 MRSA肺炎患儿常合并肺部并发症和肺外感染灶,病死率较高,ST59-SCCmec IVt437是儿童MRSA肺炎主要流行克隆,ST59型菌株是携带pvl基因的主要克隆,pvl基因与坏死性肺炎有相关性。OBJECTIVE To explore the molecular characteristics,pvl gene carrying,and drug resistance of clinical methicillin-resistant Staphylococcus aureus（MRSA）isolates from children so as to provide guidance for clinical monitoring and treatment.METHODS The clinical data were collected from the children with MRSA pneumonia who were hospitalized in 4hospitals from 2010 to 2015,totally 52 clinical isolates were isolated,the clinical characteristics were observed.The MLST,spa,SCCmec,and agr genotyping were carried out for the MRSA strains,the pvl virulence gene was detected in the clinical isolates,and the in vitro drug susceptibility testing was performed by using agar dilution method.RESULTS Of the 52 children with MRSA pneumonia,21（40.5%）had empyema,10（19.2%）had respiratory failure,6（11.5%）had necrotizing pneumonia,21（40.4%）were complicated with extrapulmonary infections,and 5died,with the mortality rate 9.6%.The ST59 was most common among the 11 types of MLST and accounted for 50.0%,followed by the ST239（25.0%）.Among the SCCmectypes,the SCCmecⅣaccounted for 59.6%,and the SCCmecⅢaccounted for 28.8%.Among the 3types of agr,the typeⅠaccounted for 84.6%.The type ST59-SCCmec IV-t437 was the major prevalent clone,accounting for 44.2%;18（34.6%）strains carried the pvl gene,most of which were the type ST59 strains.The carrying rate of the pvl gene was significantly higher in the strains isolated from the children with necrotizing pneumonia than in the strains isolated from the children with non-necrotizing pneumonia（P〈0.05）.Of all the strains,55.8% were multidrug-resistant,and the strains were susceptible to vancomycin,linezolid,and fusidic acid.CONCLUSION The children with MRSA pneumonia usually have pulmonary complications and extrapulmonary infections,and the mortality rate is relatively high.The type 59-SCCmecIV-t437 is the major prevalent clone in the children with MRSA pneumonia,the type ST59 strains are dominant among the clone strains harboring the pvl gene,and the pvl gene is assoc

关 键 词：耐甲氧西林金黄色葡萄球菌 肺炎 儿童 分子学 

分 类 号：R378.11[医药卫生—病原生物学]