Chi Chia-Yu, Wang Shih-Min, Lin Hui-Chen, Liu Ching-Chuan
Division of Clinical Research, National Health Research Institutes, Zhunan, Taiwan.
Clin Infect Dis. 2006 Jan 15;42(2):181-5. doi: 10.1086/498901. Epub 2005 Dec 12.
This study was designed to compare the clinical characteristics, toxin expression, virulence factors, and antimicrobial susceptibilities of staphylococci isolated from Taiwanese children with staphylococcal toxic shock syndrome (STSS) and staphylococcal scalded skin syndrome (SSSS).
Demographic characteristics, hospital course, and outcomes of the children were analyzed. Toxin-specific and virulence genes of the staphylococci were detected by polymerase chain reaction amplification. Antimicrobial susceptibilities were determined by disk diffusion and the Etest.
Staphylococcus aureus was isolated from 16 children (6 in the STSS group and 10 in the SSSS group). Children with STSS tended to be older than those with SSSS, had a longer duration of hospitalization, and a much higher mortality rate. Community-associated methicillin-resistant S. aureus was isolated from 11 (68.8%) of 16 children. All of these isolates contained the ermB and mecA genes, but none had the mefA gene. All 16 isolates tested positive for the fnbA gene. The pvl and seb genes were more frequently found among S. aureus from the STSS group, compared with S. aureus from the SSSS group. We found that 67% (4 of 6) of the STSS isolates were genetically related. All of the S. aureus isolates were susceptible to vancomycin, gentamicin, doxycycline, and trimethoprim-sulfamethoxazole. Most isolates were resistant to clindamycin (63%), oxacillin (69%), and clarithromycin (81%).
The most distinguishing feature of these isolates is the greater frequency of pvl and seb carriage among those from the STSS group. Most of the isolates were community-associated methicillin-resistant S. aureus that were highly resistant to macrolides but susceptible to trimethoprim-sulfamethoxazole. Vancomycin remains the initial drug of choice for treatment of STSS and SSSS. More studies are needed to determine the efficacy of trimethoprim-sulfamethoxazole in children with these syndromes.
本研究旨在比较从台湾患有葡萄球菌中毒性休克综合征（STSS）和葡萄球菌烫伤样皮肤综合征（SSSS）的儿童中分离出的葡萄球菌的临床特征、毒素表达、毒力因子及抗菌药敏情况。
分析患儿的人口统计学特征、住院病程及转归。通过聚合酶链反应扩增检测葡萄球菌的毒素特异性基因和毒力基因。采用纸片扩散法和Etest法测定抗菌药敏情况。
从16名儿童中分离出金黄色葡萄球菌（STSS组6例，SSSS组10例）。STSS患儿年龄往往比SSSS患儿大，住院时间更长，死亡率更高。16名儿童中有11名（68.8%）分离出社区获得性耐甲氧西林金黄色葡萄球菌。所有这些分离株均含有ermB和mecA基因，但均无mefA基因。16株分离株fnbA基因检测均为阳性。与SSSS组的金黄色葡萄球菌相比，pvl和seb基因在STSS组的金黄色葡萄球菌中更常见。我们发现67%（6株中的4株）的STSS分离株具有基因相关性。所有金黄色葡萄球菌分离株对万古霉素、庆大霉素、多西环素和复方新诺明敏感。大多数分离株对克林霉素（63%）、苯唑西林（69%）和克拉霉素（81%）耐药。
这些分离株最显著的特征是STSS组中携带pvl和seb的频率更高。大多数分离株为社区获得性耐甲氧西林金黄色葡萄球菌，对大环内酯类高度耐药，但对复方新诺明敏感。万古霉素仍然是治疗STSS和SSSS的首选初始药物。需要更多研究来确定复方新诺明对患有这些综合征儿童的疗效。
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