儿童患者耐甲氧西林金黄色葡萄球菌的流行病学特征及耐药性分析  

Analysis of epidemiological characteristics and antimicrobial resistance to methicillin-resistant Staphylococcus aureus isolated from pediatric patients

作　　者：李惠春 丁圣刚[1] 卜笑松[1] 王建[1] 王旺 朱玉林[1] Li Huichun;Ding Shenggang;Bu Xiaosong(Dept of Pediatrics,The First Affiliated Hospital of Anhui Medical University,Hefei 230022)

机构地区：[1]安徽医科大学第一附属医院儿科,合肥230022

出　　处：《安徽医科大学学报》2019年第4期651-655,共5页Acta Universitatis Medicinalis Anhui

基　　金：安徽省自然科学基金(编号:1408085QH157)

摘　　要：分析安徽省内儿童与>14岁患者感染耐甲氧西林金黄色葡萄球菌(MRSA)的流行病学特征及耐药性差异,为儿童感染临床治疗提供病原学依据。临床分离金黄色葡萄球菌(SA)738株,所有菌株进行药敏试验并通过PCR扩增技术检测mecA、杀白细胞素(pvl)基因,然后按年龄分组对所有菌株的mecA基因、pvl基因、科室来源、标本来源及耐药性进行统计学分析。738株SA检测为MRSA菌株共126株,占17.07%,pvl阳性菌株36株,阳性率为28.57%。其中分离自儿童患者MRSA菌株32株,占20.92%,pvl阳性MRSA菌株7株,阳性率为21.88%,与>14岁患者感染SA的mecA及pvl基因检出率差异无统计学意义。儿童患者感染MRSA主要来源于烧伤科(31.25%)、外科(15.63%)、ICU(9.38%),其中pvl(+)MRSA主要来源于外科(57.14%)、新生儿病区(28.57%)、呼吸内科(14.29%),儿童与>14岁患者感染MRSA主要来源科室之间差异有统计学意义(P<0.001)。儿童感染MRSA主要来源标本为脓液(31.25%)、痰(25.00%)、创面(15.63%),pvl(+)MRSA主要来源于脓液(71.43%)、血(28.57%),与>14岁患者感染MRSA标本来源之间差异有统计学意义(P<0.05)。儿童患者感染pvl(+)MRSA主要对β-内酰胺类、大环内酯类、氨基糖苷类、四环素类、林克酰胺类耐药;pvl(-)MRSA主要对β-内酰胺类、林克酰胺类、大环内酯类、氨基糖苷类、喹诺酮类、磺胺类、四环素类耐药,儿童与>14岁患者感染MRSA的耐药性差异无统计学意义。安徽省各地区儿童患者与>14岁患者感染MRSA的流行病学特征差异有统计学意义(P<0.05),耐药性差异无统计学意义,临床儿科医师应注意以上高发科室及标本感染SA的mecA及pvl基因鉴定并根据药敏结果合理用药以达到更好的治疗目的。To investigate the difference of epidemiological characteristics and resistance to methicillin-resistant Staphylococcus aureus(MRSA)between children and patients over 14 years of age to provide etiological basis for clinical treatment of children with infections.Drug sensitivity test were performed on 738 clinical Staphylococcus aureus(SA)isolates.The polymerase chain reaction were used to detect their mecA gene and Panton-Valentine Leukocidin(pvl)gene,and then data on mecA gene,pvl gene,department sources,specimen sources were statistically analyzed by age groups.MRSA accounted for 17.07%(126/738),pvl gene-positive MRSA accounted for 28.57%(36/126).MRSA isolated from children accounted for 20.92%(32/153),pvl(+)MRSA accounted for 21.88%(7/32).The detection rate for mecA gene and pvl gene between pediatric patients group and patients over 14 years of age group displayed no statistical significance.Children infected MRSA mainly came from burns ward(31.25%),surgery(15.63%)and ICU(9.38%).Pvl(+)MRSA mainly came from surgery(57.14%),neonatal ward(28.57%)and department of respiratory medicine(14.29%).There was statistical significance between the department sources the two groups(P<0.001).Children infected MRSA mainly came from pus(31.25%),sputum(25.00%)and wound surface(15.63%).Pvl(+)MRSA mainly came from pus(71.43%)and blood(28.57%).The difference of specimen sources between the two groups had statistical significance(P<0.05).Pediatric patients infected pvl(+)MRSA mainly resistant toβ-lactams,Macrolides,Aminoglycosides,Tetracyclines and Linkeramides.Pvl(-)MRSA mainly resistant toβ-lactams,Linkeramide,Macrolides,Aminoglycosides,Quinazolones,Sulfonamides and Tetracyclines.The difference of drug resistance between the two groups had no statistical significance.There was statistical difference of epidemiological characteristics to MRSA between the two groups(P<0.05).Clinical pediatric physician should notice the identification of mecA and pvl gene of the SA separated from the departments and specimen mentioned above and

关 键 词：耐甲氧西林金黄色葡萄球菌 杀白细胞素 流行病学 耐药性 

分 类 号：R378.11[医药卫生—病原生物学] R331.123[医药卫生—基础医学]