儿童患者分离金黄色葡萄球菌的临床分布特点及基因型  

Clinical distribution characteristics and genotypes of Staphylococcus aureus in pediatric patients

作　　者：房锐颖 黄莉莉[1] 张亚萍[1] 柏振江[1] 徐俊[1] FANG Rui-ying;HUANG Li-li;ZHANG Ya-ping;BAI Zhen-jiang;XU Jun(Department of Clinical Medicine,Children’s Hospital of Soochow University,Suzhou 215002,China)

机构地区：[1]苏州大学附属儿童医院检验科,江苏苏州215002

出　　处：《中国感染控制杂志》2023年第4期418-423,共6页Chinese Journal of Infection Control

基　　金：江苏省自然科学基金(面上)项目(BK20211077)。

摘　　要：目的了解某地区儿童患者分离金黄色葡萄球菌(SA)的临床分布特点、耐药性,以及耐甲氧西林的金黄色葡萄球菌(MRSA)的SCC mec分型、PVL基因表达情况,为预防及治疗MRSA感染提供依据。方法回顾性分析2016—2021年苏州某儿童医院各类临床标本中检出SA及MRSA的临床分布及耐药性特点。聚合酶链反应(PCR)法检测161株MRSA的mec A、SCC mec分型及PVL基因表达情况。结果2016—2021年该院共检出SA 4967株,其中MRSA 1730株(34.83%),2018年MRSA检出率(39.25%)最高。MRSA主要来源于痰(1091株)、脓液(382株)及耳脓(149株)。住院患儿不同年份间MRSA检出率比较,差异有统计学意义(P<0.001),而门诊患儿不同年份间MRSA检出率比较,差异无统计学意义(P=0.885)。SA对青霉素耐药率较高,未检出万古霉素、替考拉宁及利奈唑胺耐药菌株。MRSA对大环内酯类、四环素类抗生素的耐药率高于甲氧西林敏感的金黄色葡萄球菌(MSSA)(P<0.01),但对喹诺酮类、氨基糖苷类、复方磺胺甲噁唑耐药率低于MSSA组(P<0.01)。161株MRSA全部表达mec A基因,不表达PVL基因。SCC mec分型以SCC mecⅡ型(63.98%)为主,其次为SCC mecⅤ(16.77%)、SCC mecⅢ(12.42%)。结论近年来该医院MRSA检出率虽有下降,但仍在30%左右,社区获得性感染是MRSA的重要来源。该地区儿童MRSA控制除应加强抗菌药物管理、细菌耐药监测及医院感染控制等措施外,还需加强社区管理,以降低MRSA的发生率。Objective To understand the clinical distribution characteristics and antimicrobial resistance of Staphy-lococcus aureus(SA),as well as the staphyloccal casette chromosomal mec(SCC mec)typing and panton-valentine leukocdin(PVL)gene expression of methicillin-resistant SA(MRSA)in local pediatric patients,so as to provide evidence for the prevention and treatment of MRSA infection.Methods Clinical distribution and antimicrobial resistance characteristics of SA and MRSA isolated from various clinical specimens of a children’s hospital in Suzhou from 2016 to 2021 were analyzed retrospectively.The mec A,SCC mec typing and PVL gene expression of 161 MRSA strains were detected by polymerase chain reaction(PCR).Results A total of 4967 SA strains were detected in this hospital from 2016 to 2021,of which 1730 strains(34.83%)were MRSA,detection rate of MRSA in 2018(39.25%)was the highest.Detection rate of MRSA in 2018(39.25%)was the highest.MRSA mainly came from sputum(1091 strains),pus(382 strains),and ear pus(149 strains).Detection rates of MRSA from hospitalized children in different years were significantly different(P<0.001),while those from outpatient children in different years were not(P=0.885).SA showed a high resistance rate to penicillin,but no strains resistant to vancomycin,teicoplanin or linezolid were detected.The resistance rates of MRSA to macrolides and tetracyclines were higher than those of methicillin-sensitive SA(MSSA)(P<0.01),but the resistance rates to quinolones,aminoglycosides,and trimethoprim-sulfamethoxazole were lower than those of MSSA(P<0.01).All of the 161 MRSA strains expressed the mec A gene,but not the PVL gene.SCC mec typeⅡ(63.98%)was the main type of SCC mec,followed by SCC mecⅤ(16.77%)and SCC mecⅢ(12.42%).Conclusion Although the detection rate of MRSA in this hospital has decreased in recent years,it is still around 30%.Community-acquired infection is an important source of MRSA.Therefore,in addition to strengthening measures such as antimicrobial management,bacterial antimicrobi

关 键 词：耐甲氧西林的金黄色葡萄球菌 SCC mec分型 PVL基因 

分 类 号：R181.32[医药卫生—流行病学]