儿童皮肤软组织感染社区相关性耐甲氧西林金黄色葡萄球菌分子特征多中心研究  

Multicenter study on the molecular characteristics of community - associated Methicillin - resistant Staphylo- coccus aureus in children with skin and soft tissue infection

作　　者：刘盈[1] 孙娟[1] 杨舟[1] 马琳[1] 

机构地区：[1]首都医科大学附属北京儿童医院皮肤科,儿科学国家重点学科,儿科重大疾病研究教育部重点实验室,100045

出　　处：《中华实用儿科临床杂志》2017年第10期752-755,共4页Chinese Journal of Applied Clinical Pediatrics

基　　金：国家自然科学基金（81201237）;北京市医院管理局临床医学发展专项（ZYLX201601）;北京市医院管理局“青苗”计划专项（QML20151101）;北京儿童医院临床-科研苗圃项目（BCHYIPA-2016-11）

摘　　要：目的明确我国儿童皮肤软组织感染（skin and soft tissue infections，SSTIs）社区相关性耐甲氧西林金黄色葡萄球菌（community－associated Methicillin－resistant Staphylococcus aureus，CA－MRSA）的分子生物学特征。方法收集我国13家儿童医院皮肤科门诊SSTIs来源的CA－MRSA，进行多位点基因分型（MLST）、葡萄球菌A蛋白序列（spa）分型及葡萄球菌盒式染色体（SCCmec）分型，同时进行杀白细胞毒素（Panton－Valentine Leukocidin，pvl）基因检测。结果1 705株金黄色葡萄球菌来自SSTIs患儿，临床共分离CA－MRSA 44株，分离率仅为2.6%（44/1 705株）。44株CA－MRSA共检测到2种SCCmec分型，为SCCmec Ⅳ和SCCmec Ⅴ型，分别占45.5%（20/44株）和54.5%（24/44株）；13个MLST型别中，最主要的MLST型别是ST121（18/44株，40.9%），其次是ST59（9/44株，20.5%）；15种spa型别中，最主要的spa型别是t437（18/44株，40.9%）。ST121菌株有8种spa型别，以t2086最常见（6/18株，33.3%），而ST59仅有1种spa型别，即t437。华中与华东地区未见ST121、ST59和t437菌株型别。44株CA－MRSA中pvl阳性率为9.1%（4/44株），均来自南部地区。Objective To explore the molecular characteristics of community-associated Methicillin-resis-tant Staphylococcus aureus （CA-MRSA） from children with skin and soft tissue infection （SSTIs） in China.Methods CA-MRSA was collected from the outpatients in Department of Dermatology in 13 Children′s Hospitals of China.Genotypic characteristics of CA-MRSA isolates were tested by adopting multilocus sequence typing （MLST）, staphylococcal protein A （spa） typing and Staphyloccoccal cassette chromosome mec （SCCmec） typing.And the presence of Panton-Valentine leukocidin genes（pvl） was determined also.Results Overall, 1 705 strains of Staphylococcus aureus were isolated from SSTIs children, and CA-MRSA accounted for 2.6% （44/1 705 strains）. Two types of SCCmec were detected in all the CA-MRSA strains, and the main types were SCCmec Ⅳ and SCCmec Ⅴ, accounting for 45.5% （20/44 strains） and 54.5% （24/44 strains）, respectively.Thirteen MLST types （STs） and 15 spa types were detected among CA-MRSA.The most prevalent MLST was ST121 （18/44 strains, 40.9%）, followed by ST59 （9/44 strains, 20.5%）. Additionally, t437 was predominant, accounting for 40.9% （18/44 strains）. ST121 strain had 8 spa types, and t2086 was the most common type （6/18 strains, 33.3%）; while ST59 had only 1 spa type, t437.No ST121, ST59 and t437 strains were found in Central and Eastern region of China.Only 4 （9.1%） of the 44 CA-MRSA strains harbored pvl genes which were all from Southern region.Conclusions The most common clone of SSTIs CA-MRSA in children is MRSA-ST121- SCCmec Ⅳ/Ⅴ, as the molecular epidemiology of CA-MRSA strain has changed, ST121 has replaced ST59 to become the main epidemic strains.

关 键 词：社区相关性耐甲氧西林金黄色葡萄球菌 皮肤软组织感染 分子特征 儿童 中国 

分 类 号：R446.5[医药卫生—诊断学] R753[医药卫生—临床医学]