癌症患儿中的杀白细胞素阳性耐甲氧西林金黄色葡萄球菌感染
Panton-Valentine leukocidin-positive methicillin-resistant Staphylococcus aureus infections in children with cancer.
作者信息
Srinivasan Ashok, Seifried Steven, Zhu Liang, Srivastava Deo K, Flynn Patricia M, Shenep Jerry L, Bankowski Matthew J, Hayden Randall T
机构信息
Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee 38105, USA.
出版信息
Pediatr Blood Cancer. 2009 Dec 15;53(7):1216-20. doi: 10.1002/pbc.22254.
BACKGROUND
New strains of methicillin-resistant Staphylococcus aureus (MRSA) which frequently carry the Panton-Valentine leukocidin (PVL) genes have been recognized to cause invasive infections in otherwise healthy children and adults. However, the epidemiology of PVL-positive MRSA infections has not been described in children or adults with cancer.
PROCEDURE
The epidemiology of MRSA infections in patients with cancer was retrospectively studied from 2000 to 2007. Molecular typing was performed by polymerase chain reaction (PCR) for the detection of the PVL genes. Staphylococcus cassette chromosome (SCC) mec and spa typing was performed on all PVL-positive isolates.
RESULTS
A total of 88 MRSA isolates from clinically distinct infectious episodes were collected from 88 patients with cancer during the 8-year study period. Infections were predominant in the skin and soft tissues (SSTI; P = 0.0003). PVL-positive isolates, bearing the type IV SCCmec element, encoding the gene for methicillin resistance, increased significantly during this period (P = 0.043) and comprised 35 of 88 (40%) MRSA isolates. Of these 35 isolates, 32 belonged to spa type 8 and were USA300 genotype. Patients infected with PVL-positive strains did not have more SSTI (P = 0.166) or bacteremia (P = 0.510) as compared to patients with PVL-negative strains. A greater percentage of PVL-positive isolates were susceptible to ciprofloxacin (P = 0.006).
CONCLUSIONS
PVL-positive MRSA infections are not associated with a higher morbidity as compared to PVL-negative MRSA infections in children with cancer.
背景
新出现的耐甲氧西林金黄色葡萄球菌（MRSA）菌株常携带杀白细胞素（PVL）基因，已被确认可在原本健康的儿童和成人中引起侵袭性感染。然而，PVL阳性MRSA感染在癌症儿童或成人中的流行病学情况尚未见报道。
方法
对2000年至2007年癌症患者中MRSA感染的流行病学情况进行回顾性研究。通过聚合酶链反应（PCR）进行分子分型以检测PVL基因。对所有PVL阳性分离株进行葡萄球菌盒式染色体（SCC）mec和spa分型。
结果
在为期8年的研究期间，从88例癌症患者中收集了88株来自临床不同感染发作的MRSA分离株。感染主要发生在皮肤和软组织（皮肤和软组织感染；P = 0.0003）。在此期间，携带IV型SCCmec元件、编码耐甲氧西林基因的PVL阳性分离株显著增加（P = 0.043），在88株MRSA分离株中占35株（40%）。在这35株分离株中，32株属于spa型8，为USA300基因型。与PVL阴性菌株感染的患者相比，PVL阳性菌株感染的患者皮肤和软组织感染（P = 0.166）或菌血症（P = 0.510）并无更多。更高比例的PVL阳性分离株对环丙沙星敏感（P = 0.006）。
结论
与癌症儿童中PVL阴性MRSA感染相比，PVL阳性MRSA感染并未导致更高的发病率。
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