Hira Vishal, Sluijter Marcel, Estevão Silvia, Horst-Kreft Deborah, Ott Alewijn, de Groot Ronald, Hermans Peter W M, Kornelisse René F
Department of Pediatrics, Erasmus MC--Sophia Children's Hospital, Rotterdam, The Netherlands.
Pediatr Infect Dis J. 2007 Jul;26(7):607-12. doi: 10.1097/INF.0b013e318060cc03.
This study aimed to determine clinical characteristics of coagulase-negative staphylococcal (CoNS) sepsis in neonates, to assess the molecular epidemiology and biofilm forming properties of isolated strains, and to assess antibiotic susceptibility of clonal compared with incidentally occurring strains.
We performed a retrospective study on late-onset CoNS sepsis in infants in the neonatal intensive care unit of a Dutch university hospital in 2003. CoNS isolates were genotyped by restriction fragment end labeling and pulsed-field gel electrophoresis. Resistance profiles, biofilm production, and the presence of mecA and icaA were determined.
Twenty-six percent of all 339 infants developed late-onset sepsis, 66% of these with CoNS sepsis. Eighty-six percent of all CoNS sepsis occurred in very low birth weight infants. Sixty-six CoNS strains were isolated. In multivariate analysis, small for gestational age and prolonged hospitalization were associated with CoNS sepsis. Among 3 restriction fragment end labeling clusters, we found 1 large cluster comprising 32% of the isolates. Biofilm producing Staphylococcus epidermidis were more frequently icaA positive than nonbiofilm formers (74% vs. 12%; P < 0.001). In other species, this association was not found. Nearly all isolates were resistant to antibiotics. MecA was present in 87% of the isolates. Multiresistance occurred in 77% of all strains and in 73% of clustered strains. There was significantly less multiresistance among the largest cluster.
Small for gestational age and prolonged hospitalization were associated with CoNS sepsis. The icaA gene is a predictor for biofilm formation in S. epidermidis, but not in other species. Multiresistance is not associated with clonality.
本研究旨在确定新生儿凝固酶阴性葡萄球菌（CoNS）败血症的临床特征，评估分离菌株的分子流行病学和生物膜形成特性，并评估克隆菌株与偶发菌株的抗生素敏感性。
我们对2003年荷兰一家大学医院新生儿重症监护病房中婴儿的晚发性CoNS败血症进行了一项回顾性研究。通过限制性片段末端标记和脉冲场凝胶电泳对CoNS分离株进行基因分型。测定耐药谱、生物膜产生情况以及mecA和icaA的存在情况。
在所有339名婴儿中，26%发生了晚发性败血症，其中66%为CoNS败血症。所有CoNS败血症中有86%发生在极低出生体重儿中。共分离出66株CoNS菌株。多因素分析显示，小于胎龄儿和住院时间延长与CoNS败血症有关。在3个限制性片段末端标记簇中，我们发现1个大簇，包含32%的分离株。产生物膜的表皮葡萄球菌icaA阳性的频率高于不产生物膜的菌株（74%对12%；P<0.001）。在其他菌种中未发现这种关联。几乎所有分离株都对抗生素耐药。87%的分离株中存在mecA。77%的所有菌株和73%的簇状菌株存在多重耐药。最大的簇中多重耐药明显较少。
小于胎龄儿和住院时间延长与CoNS败血症有关。icaA基因是表皮葡萄球菌生物膜形成的预测指标，但在其他菌种中不是。多重耐药与克隆性无关。
