Fortunov Regine M, Hulten Kristina G, Hammerman Wendy A, Mason Edward O, Kaplan Sheldon L
Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA.
Pediatrics. 2006 Sep;118(3):874-81. doi: 10.1542/peds.2006-0884.
Community-acquired, methicillin-resistant Staphylococcus aureus infections are increasing among children.
Our goal is to describe the clinical presentation of neonatal community-acquired S aureus disease and provide molecular analyses of the infecting isolates.
We retrospectively reviewed the demographics and hospital course of term and near-term previously healthy neonates, < or = 30 days of age, with community-acquired S aureus infections presenting after nursery discharge between August 2001 and March 2005 at Texas Children's Hospital. Prospectively collected isolates were characterized by pulsed-field gel electrophoresis, staphylococcal cassette chromosome mec type, and the presence of PVL genes.
Of 89 S aureus infections, 61 were methicillin-resistant S aureus; S aureus infections increased each year. Methicillin-resistant S aureus infections increased from 10 of 20 to 30 of 36 infections from 2002 to 2004. Most subjects, 65 of 89, were male. Symptoms began at 7 to 12 days of age for 26 of 45 male infants with methicillin-resistant S aureus. Most infections, 77 of 89, involved skin and soft tissue; 28 of 61 methicillin-resistant S aureus versus 7 of 28 methicillin-susceptible S aureus infections required drainage. Invasive manifestations included shock, musculoskeletal and urinary tract infection, perinephric abscess, bacteremia, empyema/lung abscess, and a death. Maternal S aureus or skin-infection history occurred with 13 of 61 methicillin-resistant S aureus versus 1 of 28 methicillin-susceptible S aureus infections. The predominant community clone, USA300 (PVL genes +), accounted for 55 of 57 methicillin-resistant S aureus and 3 of 25 methicillin-susceptible S aureus isolates.
Community-acquired methicillin-resistant S aureus is a substantial and increasing proportion of S aureus infections in previously healthy neonates. Male infants 7 to 12 days of age are affected most often. Neonatal community-acquired S aureus infection may be associated with concurrent maternal infection. USA300 is the predominant clone among these neonatal isolates in our region.
社区获得性耐甲氧西林金黄色葡萄球菌感染在儿童中日益增多。
我们的目标是描述新生儿社区获得性金黄色葡萄球菌病的临床表现，并对感染菌株进行分子分析。
我们回顾性分析了2001年8月至2005年3月在德克萨斯儿童医院出院后出现社区获得性金黄色葡萄球菌感染的足月儿和近足月儿（年龄≤30天）的人口统计学资料和住院病程。对前瞻性收集的菌株进行脉冲场凝胶电泳、葡萄球菌盒式染色体mec分型以及PVL基因检测。
89例金黄色葡萄球菌感染中，61例为耐甲氧西林金黄色葡萄球菌；金黄色葡萄球菌感染逐年增加。耐甲氧西林金黄色葡萄球菌感染从2002年的20例中的10例增加到2004年的36例中的30例。89例中大多数（65例）为男性。45例耐甲氧西林金黄色葡萄球菌感染的男婴中，26例在7至12日龄开始出现症状。89例感染中，大多数（77例）累及皮肤和软组织；61例耐甲氧西林金黄色葡萄球菌感染中有28例与28例甲氧西林敏感金黄色葡萄球菌感染中的7例需要引流。侵袭性表现包括休克、肌肉骨骼和泌尿系统感染、肾周脓肿、菌血症、脓胸/肺脓肿以及1例死亡。61例耐甲氧西林金黄色葡萄球菌感染中有13例产妇有金黄色葡萄球菌或皮肤感染史，而28例甲氧西林敏感金黄色葡萄球菌感染中仅有1例。主要的社区克隆株USA300（PVL基因阳性）占57例耐甲氧西林金黄色葡萄球菌中的55例和25例甲氧西林敏感金黄色葡萄球菌中的3例。
社区获得性耐甲氧西林金黄色葡萄球菌在既往健康的新生儿金黄色葡萄球菌感染中占相当比例且呈上升趋势。7至12日龄男婴最常受累。新生儿社区获得性金黄色葡萄球菌感染可能与产妇同时感染有关。USA300是我们地区这些新生儿分离株中的主要克隆株。
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