儿童耐甲氧西林金黄色葡萄球菌鼻腔定植的变化：2004-2009 年。
Changes in the nasal colonization with methicillin-resistant Staphylococcus aureus in children: 2004-2009.
机构信息
Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
出版信息
PLoS One. 2010 Dec 29;5(12):e15791. doi: 10.1371/journal.pone.0015791.
BACKGROUND
Staphylococcus aureus is an important cause of infection, particularly in persons colonized with this organism. This study compared the annual prevalence and microbiological characteristics of methicillin-resistant S. aureus (MRSA) nasal colonization in Taiwanese children from 2004 through 2009. Risk factors for MRSA were determined for the overall study period.
METHODS
Children from birth to ≤14 years of age presenting for health maintenance visits or attending 1 of 57 kindergartens were recruited. Nasal swabs were obtained, and a questionnaire was administered. The prevalence and microbiological characteristics of MRSA colonization were also calculated for two 3-year periods: 2004-2006 and 2007-2009.
RESULTS
Cultures of the anterior nares were positive for S. aureus in 824 (25.8%) of the 3,200 children, and MRSA colonization was found in 371 (11.6%) children. The prevalence of S. aureus colonization decreased from 28.1% in 2004-2006 to 23.3% in 2007-2009 (p<0.01), whereas the prevalence of MRSA colonization increased from 8.1% to 15.1% during this period (p<0.0001). Multivariate analysis revealed that the independent risk factors for MRSA carriage were different for male and female children, and also among age groups. Most MRSA isolates belonged to sequence type 59 (ST59) (86.3%); however, a multiresistant MRSA clone with ST338 background emerged in 2007-2009. Ten (62.5%) of the 16 MRSA isolates expressed the genotypic profile ST338/staphylococcal cassette chromosome mec V(T)/Panton-Valentine leukocidin-positive/staphylococcal enterotoxin B-positive, and differed only in their antimicrobial susceptibility patterns.
CONCLUSION
The prevalence of nasal colonization by MRSA increased among healthy Taiwanese children from 2004-2006 to 2007-2009, despite an overall decrease in the prevalence of nasal colonization by S. aureus. A multiresistant MRSA clone characterized as ST338 was identified from these children.
背景
金黄色葡萄球菌是感染的重要原因，特别是在定植该病原体的人群中。本研究比较了 2004 年至 2009 年台湾儿童中耐甲氧西林金黄色葡萄球菌（MRSA）鼻腔定植的年度流行率和微生物学特征。确定了整个研究期间 MRSA 的危险因素。
方法
招募了出生至≤14 岁，参加健康维护就诊或 57 家幼儿园之一的儿童。获取鼻腔拭子，并进行问卷调查。还计算了 2004-2006 年和 2007-2009 年两个 3 年期间的 MRSA 定植的流行率和微生物学特征。
结果
在 3200 名儿童中，有 824 名（25.8％）的前鼻孔培养物为金黄色葡萄球菌阳性，有 371 名（11.6％）儿童为 MRSA 定植。2004-2006 年金黄色葡萄球菌定植率从 28.1％降至 2007-2009 年的 23.3％（p<0.01），而同期 MRSA 定植率从 8.1％增至 15.1％（p<0.0001）。多变量分析显示，男性和女性儿童以及不同年龄组之间，MRSA 携带的独立危险因素不同。大多数 MRSA 分离株属于序列型 59（ST59）（86.3％）；然而，2007-2009 年出现了一种具有 ST338 背景的多药耐药 MRSA 克隆。16 株 MRSA 分离株中有 10 株（62.5％）表达基因型谱 ST338/葡萄球菌盒染色体 mec V（T）/Panton-Valentine 白细胞毒素阳性/葡萄球菌肠毒素 B 阳性，仅在其抗菌药物敏感性模式上存在差异。
结论
尽管金黄色葡萄球菌鼻腔定植的总体流行率有所下降，但 2004-2006 年至 2007-2009 年期间，健康台湾儿童的 MRSA 鼻腔定植率有所增加。从这些儿童中鉴定出一种多药耐药的 MRSA 克隆，其特征为 ST338。
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