上海市闵行区2023—2024年儿童猩红热的分子流行病学特征  

Molecular epidemiological characteristics of scarlet fever among children in Minhang District,Shanghai,2023-2024

作　　者：张驰 陈穸 童锐[1] 刘小华 ZHANG Chi;CHEN Xi;TONG Rui;LIU Xiaohua(Department of Microbiology,Minhang District Centre for Disease Control and Prevention,Shanghai 201101,China)

机构地区：[1]上海市闵行区疾病预防控制中心微检科,上海201101

出　　处：《中国热带医学》2024年第12期1458-1464,共7页China Tropical Medicine

基　　金：上海市加强公共卫生体系建设三年行动计划项目(No.GWVI-3)

摘　　要：目的 分析并掌握2023—2024年上海市闵行区儿童A族链球菌(group A Streptococcus,GAS)引起猩红热的流行特征,为临床治疗和感染控制提供相关信息。方法 收集2023年5月—2024年6月上海市闵行区哨点医院中临床诊断为猩红热的儿童咽拭子样本,采用血平板分离培养细菌,质谱鉴定种属,聚合酶链反应(polymerase chain reaction,PCR)法检测emm基因分型和11种超抗原,微量肉汤稀释法测定菌株对14种抗菌药物的耐药性;对其中68株GAS菌株进行全基因组测序;利用χ^(2)检验和Fisher's确切概率法进行组间比较。结果 共收集305例儿童猩红热病例的咽拭子标本,分离培养获得178株GAS菌株。菌株均对青霉素、头孢噻肟、利奈唑胺、万古霉素、美罗培南、氯霉素、左氧氟沙星、替考拉宁、头孢吡肟敏感,对红霉素、克林霉素、四环素的耐药率分别为99.44%、99.44%和94.94%。存在2种emm型,emm12型(89.33%,159/178)最多,其次为emm1型(10.67%,19/178)。存在26种超抗原基因谱。emm1型GAS的speA基因携带率(94.74%,18/19)高于emm12型(12.00%,32/159)(χ^(2)=46.77,P<0.001)。emm12型GAS的speH和speI基因同时携带率(59.75%,95/159)高于emm1型(0)(χ^(2)=24.35,P<0.001)。全基因组测序结果显示68株GAS菌株全部携带耐药基因ermB,其中98.52%(67/68)携带tetM。结论 上海市闵行区儿童非侵袭猩红热大都由emm12型GAS导致,主要对红霉素、克林霉素和四环素具有高度耐药性,且emm12型speH和speI的携带率高于其他型菌株。Objective To explore and analyze the epidemiological characteristics of scarlet fever caused by group A Streptococcus(GAS)in Minhang District,Shanghai from 2023 to 2024,providing relevant information for clinical treatment and infection control.Methods Throat swab specimens were collected from children clinically diagnosed with scarlet fever at a sentinel hospital in Shanghai from May 2023 to June 2024.GAS strains were isolated and cultured using blood agar plates,and mass spectrometry performed species identification.The polymerase chain reaction(PCR)method was used to assess emm gene typing and 11 superantigens,while the broth microdilution method was used to determine the resistance of the strains to 14 antibiotics.Whole genome sequencing was performed on 68 GAS strains.The chi-square test and Fisher's exact probability method were conducted for intergroup comparisons.Results A total of 178 GAS strains were isolated from 305 throat swab specimens of scarlet fever cases in children.All GAS strains were sensitive to penicillin,cefotaxime,linezolid,vancomycin,meropenem,chloramphenicol,levofloxacin,teicoplanin,and cefepime,while the resistance rates to erythromycin,clarithromycin,and tetracycline were 99.44%,99.44%,and 94.94%,respectively.There are two types of emm genes,with emm12 being the main type(89.33%,159/178),followed by emm110.7%(19/178).There were 26 types of superantigen gene spectrums.The speA gene carrying rate of emm1 type GAS(94.74%,18/19)was significantly higher than emm12(12.00%,32/159)(χ^(2)=46.77,P<0.001).The simultaneous carrying rate of speH and speI genes in emm12 type GAS(59.75%,95/159)was higher than in emm1 type(0)(χ^(2)=24.35,P<0.001).Whole-genome sequencing revealed that all 68 GAS strains carried the drug resistance gene ermB,with 98.52%(67/68)carrying tetM.Conclusions In Minhang District of Shanghai,non-invasive scarlet fever in children is predominantly caused by emm12 GAS,which shows high resistance to erythromycin,clindamycin,and tetracycline,with higher carriage rates of speH and

关 键 词：猩红热 A组链球菌 耐药性 emm基因 超抗原 

分 类 号：R515[医药卫生—内科学]