新生儿气管切开术后早期切口金黄色葡萄球菌定植率及分子型分析  

Analysis of colonization rate and molecular characteristics of Staphylococcus aureus on tracheotomy wounds at early postoperational stage in neonates

作　　者：郁洁 田恩霞 向希盈 朱杏 杜娟 姚开虎[3] 张杰[2] 黑明燕 Yu Jie;Tian Enxia;Xiang Xiying;Zhu Xing;Du Juan;Yao Kaihu;Zhang Jie;Hei Mingyan(Neonatal Center,Beijing Children′s Hospital,Capital Medical University,Key Laboratory of Major Diseases in Children,Beijing 100045,China;Department of Otorhinolaryngology,Beijing Children′s Hospital,Capital Medical University,Beijing 100045,China;Infection and Microbiology Laboratory,Beijing Pediatric Research Institute,Key Laboratory of Major Diseases in Children,Beijing 100045,China)

机构地区：[1]首都医科大学附属北京儿童医院新生儿中心、教育部儿科重大疾病研究重点实验室,北京100045 [2]首都医科大学附属北京儿童医院耳鼻咽喉头颈外科,北京100045 [3]北京市儿科研究所感染与微生物室、教育部儿科重大疾病研究重点实验室,北京100045

出　　处：《中华儿科杂志》2025年第4期399-404,共6页Chinese Journal of Pediatrics

基　　金：北京市医院管理中心“扬帆”计划临床技术创新项目(ZLRK202528)。

摘　　要：目的分析新生儿重症监护病房(NICU)气管切开患儿的术后早期切口金黄色葡萄球菌(SA)定植率及其菌株分子型。方法病例系列研究,选择2020年1月1日至2023年12月31日在首都医科大学附属北京儿童医院NICU住院的气管切开19例新生儿。在气管切开术后24、72、168 h采集鼻腔及气管套管周围皮肤拭子进行细菌培养。采用凝固酶实验及Staphytect Plus鉴定试剂盒进行SA鉴定。通过PCR检测nuc基因的携带情况进一步鉴定SA分子型。从电子病历系统中提取和采集人口学特征、住院信息。根据是否存在SA定植及感染情况将患儿分为定植组和非定植组,感染组和非感染组。采用独立样本t检验或Fisher确切概率法分析组间差异。结果19例患儿中男13例,出生胎龄39.0(38.1,40.0)周,出生体重3150(2600,3400)g。从明确诊断至气管切开的时间间隔为8.2(4.1,19.6)d,手术时校正胎龄为43.6(42.2,45.4)周,住院时间为(34.0±3.1)d。8例患儿存在SA定植,18株定植菌中10株为耐甲氧西林金黄色葡萄球菌(MRSA),其菌株最常见分子型为ST59-SCCmecⅣ-t437(8株)。10例患儿出现肺部感染,3例血源性感染,2例中枢神经系统感染;3例患儿的体液培养为SA阳性,均为MRSA且分子型均为ST59-SCCmecⅣ-t437。定植与非定植组患儿的感染发生率差异有统计学意义(7/8比3/11,P=0.020)。结论气管切开新生儿手术部位的SA定植和感染发生率均较高,以MRSA为主,最常见分子型为ST59-SCCmecⅣ-t437。Objective To analyze the colonization rate and molecular types of Staphylococcus aureus(SA)on the tracheotomy wounds of neonates at early postoperative stage in neonatal intensive care unit(NICU).Methods This was a case series study.Patients who were admitted and underwent tracheotomy in NICU of Beijing Children′s Hospital,Capital Medical University from January 1 st 2020 to December 31 st 2023 were enrolled.Swabs on the skin around the incision or on the nasal mucosa were collected and cultured at 24,72 and 168 h after operation.Coagulase test and Staphytect Plus kits were used for SA identification.The nuc gene amplification and molecular types of SA were assessed by PCR.The patients were divided into SA colonization group and non-colonization group based on the presence or absence of SA colonization,and into infection group and non-infection group based on the presence or absence of infection.Demographic data,hospitalization information,colonization and infection status of SA were collected from the digital medical record system of the hospital.Differences between groups were analyzed using the independent sample t test or Fisher exact test.Results Totally 19 patients were enrolled,among whom 13 were male.The gestation age was 39.0(38.1,40.0)weeks,and the birth weight was 3150(2600,3400)g.Tracheotomy was done at 8.2(4.1,19.6)days after diagnosis and indication confirmed.Corrected gestational age of patients on the operation day was 43.6(42.2,45.4)weeks.The NICU stay time was(34.0±3.1)days.SA colonization was confirmed around the incision of 8 patients.Out of the 18 strains of colonized bacteria,10 were methicillin-resistant Staphylococcus aureus(MRSA).The most common molecular type of MRSA was ST59-SCCmecⅣ-t437 strain(8 strains).A total of 10 patients presented typical clinical manifestations of bacterial infection at the lungs,3 patients in the blood stream and 2 patients in the central nervous system.Among 10 patients with bacterial infection,3 patients were MRSA positive by boby fluid culture and affec

关 键 词：婴儿 新生 葡萄球菌 金黄色 定植 感染 分子型 

分 类 号：R722.1[医药卫生—儿科]