流感后CA-MRSA肺炎6例分子流行病学及临床特征分析  

Molecular epidemiology and clinical characteristics of six cases of CA-MRSA pneumonia after influenza

作　　者：钟经婧 隗明 杨春霞[1] 尹玉东[1] 白羽[1] 李冉[1] 谷丽[1] Zhong Jingjing;Wei Ming;Yang Chunxia;Yin Yudong;Bai Yu;Li Ran;Gu Li(Department of Infectious Diseases and Clinical Microbiology,Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital,Capital Medical University,Beijing 100020,China)

机构地区：[1]首都医科大学附属北京朝阳医院感染和临床微生物科北京市呼吸疾病研究所,北京100020

出　　处：《中华结核和呼吸杂志》2023年第5期480-486,共7页Chinese Journal of Tuberculosis and Respiratory Diseases

摘　　要：目的分析流感后社区获得性耐甲氧西林金黄色葡萄球菌(CA-MRSA)感染病例的分子流行病学及临床特征。方法回顾性分析2014—2022年6例流感后CA-MRSA肺炎的病例,分离培养6株CA-MRSA,进行3种分子流行病学分型(SCCmec分型、MLST分型及spa分型)、检测其毒力因子并进行药物敏感性实验;总结病例临床特征及诊疗过程。结果6株CA-MRSA中ST59-t437-Ⅳ型为主要分型(2/6);杀白细胞素(PVL)检出5例,溶血素α(HLAα)及酚溶性调节蛋白α(PSMα)检出6例。6例患者中5例为重症肺炎;治疗上,4例接受过抗病毒治疗,5例重症肺炎患者均首选万古霉素抗感染治疗且病情好转出院。结论流感后的CA-MRSA分子分型及携带的毒力因子多样;流感后继发CA-MRSA感染更常见于年轻、既往无基础疾病人群,可引起重症肺炎。流感后合并重症肺炎患者需要及时送病原学检测明确是否为CA-MRSA感染,给予抗流感病毒及抗CA-MRSA感染治疗。Objective To summarize and analyze the strains′molecular epidemiology and clinical characteristics of 6 strains of post-influenza community-associated methicillin-resistant Staphylococcus aureus(CA-MRSA)pneumonia.Methods Six cases of CA-MRSA pneumonia after influenza from 2014 to 2022 were retrospectively collected and CA-MRSA strains from each patient were cultured.Then,SCCmec typing,MLST typing,and spa typing were performed on the samples,which also included the procedures for the detection of virulence factors.Antibiotic susceptibility test was then performed on all 6 strains.Results ST59-t437-Ⅳwas the predominant type in all the strains of CA-MRSA(2/6).Leukocidin(PVL)was detected in 5 cases,and hemolysinα(HLAα)and phenol soluble regulatory proteinα(PSMα)were detected in 6 cases.Five of the cases included in this study were diagnosed with severe pneumonia.In terms of treatment,4 cases received antiviral therapy,and 5 patients with severe pneumonia received anti-infection treatment with vancomycin as the first choice and were discharged after improvement of their condition.Conclusions The molecular types and virulence factors of CA-MRSA after influenza infection could vary considerably.Our experiments also showed that secondary CA-MRSA infection after influenza was more common in young people with no underlying diseases and could cause severe pneumonia.Vancomycin and linezolid were the first-line drugs for treating CA-MRSA infection and were highly effective in improving the condition of diagnosed patients.We highlighted the importance of referring patients with severe pneumonia after influenza for etiological tests to determine whether they had CA-MRSA infection,so that they could be properly treated with anti-influenza agents and receive appropriate anti-CA-MRSA infection treatment.

关 键 词：葡萄球菌 金黄色 社区获得性感染 甲氧西林抗药性 流感 人 肺炎 

分 类 号：R563.1[医药卫生—呼吸系统]