Ellington M J, Perry C, Ganner M, Warner M, McCormick Smith I, Hill R L, Shallcross L, Sabersheikh S, Holmes A, Cookson B D, Kearns A M
Laboratory of Healthcare Associated Infections, Centre for Infections, Health Protection Agency, 61 Colindale Avenue, London NW9 5EQ, United Kingdom.
Eur J Clin Microbiol Infect Dis. 2009 Sep;28(9):1113-21. doi: 10.1007/s10096-009-0757-x. Epub 2009 May 30.
We aimed to enhance our case ascertainment of meticillin-resistant Staphylococcus aureus encoding Panton-Valentine leucocidin (PVL-MRSA), determine the patient demographic, risk factor and disease associations, and define the clonal diversity amongst isolates referred to the UK Health Protection Agency's Staphylococcus Reference Unit. PVL-MRSA collected during 2005-6 from community-based and hospitalised patients located across England and Wales were identified by polymerase chain reaction (PCR). Representative geographically and temporally unrelated isolates were characterised via toxin gene profiling, SCCmec, spa and agr typing, multilocus sequence typing (MLST) and minimum inhibitory concentration (MIC) determinations. PVL-MRSA were identified from 275 patients. Affected individuals were <1 to 95 years of age (mean 30, median 27 years). Forty-five isolates were from 18 household or community-based clusters and 23 isolates were from outbreaks in healthcare settings. Overall, 58% (n = 161) had skin and soft tissue infections and 9% (n = 25) presented with or developed more serious disease, including eight patients (3%) with necrotising pneumonia, five of whom subsequently died. PVL-MRSA were genetically diverse and harboured SCCmecIV or V(T)/VII. Representatives of MLST clonal complexes (CCs) 8, 30 and 80 were identified the most often. The 275 PVL-MRSA included internationally disseminated community-associated MRSA (CA-MRSA) strains, as well as other minor lineages, and were associated with typical risk factors and disease presentations.
我们旨在加强对编码杀白细胞素（PVL）的耐甲氧西林金黄色葡萄球菌（PVL-MRSA）的病例诊断，确定患者的人口统计学特征、风险因素及疾病关联，并明确提交至英国卫生防护局葡萄球菌参考单位的分离株的克隆多样性。通过聚合酶链反应（PCR）鉴定了2005年至2006年间从英格兰和威尔士各地社区及住院患者中收集的PVL-MRSA。通过毒素基因谱分析、SCCmec、spa和agr分型、多位点序列分型（MLST）以及最低抑菌浓度（MIC）测定，对具有代表性的、在地理和时间上不相关的分离株进行了特征分析。从275名患者中鉴定出PVL-MRSA。受影响个体的年龄在1岁至95岁之间（平均30岁，中位数27岁）。45株分离株来自18个家庭或社区聚集性病例，23株分离株来自医疗机构的暴发疫情。总体而言，58%（n = 161）的患者患有皮肤和软组织感染，9%（n = 25）的患者出现或发展为更严重的疾病，包括8名患者（3%）患有坏死性肺炎，其中5人随后死亡。PVL-MRSA在基因上具有多样性，携带SCCmecIV或V(T)/VII。MLST克隆复合体（CCs）8、30和80的代表被鉴定得最为频繁。这275株PVL-MRSA包括国际传播的社区获得性MRSA（CA-MRSA）菌株以及其他一些小谱系，并且与典型的风险因素和疾病表现相关。
