Division of Pediatric Infectious Diseases, Chang Gung Children's Hospital, Kweishan, Taoyuan, Taiwan.
Int J Antimicrob Agents. 2011 Jul;38(1):2-8. doi: 10.1016/j.ijantimicag.2011.01.011. Epub 2011 Mar 11.
Meticillin-resistant Staphylococcus aureus (MRSA) has been increasingly identified as the major cause of community-associated (CA) infections in previously healthy hosts since the late 1990s. CA-MRSA strains were recognised as a novel pathogen that is genetically different from healthcare-associated MRSA, and five major epidemic clones have been identified worldwide. In Taiwan, a significantly increasing rate of MRSA carriage and infection amongst healthy subjects was observed in the past decade. Up to 9.5% of healthy Taiwanese children carried MRSA in the nares and >50% of paediatric CA S. aureus infections were MRSA. The adult population was also affected, but this was relatively limited. The majority of CA-MRSA isolates in Taiwan belonged to the sequence type (ST) 59 lineage, defined by multilocus sequence typing, and were multiresistant to non-β-lactams. The clone of ST59 lineage can be further classified into at least two major clones by pulsed-field gel electrophoresis (PFGE) typing, staphylococcal chromosomal cassette mec (SCCmec) elements and Panton-Valentine leukocidin (PVL) genes. The clone characterised as ST59/PFGE type C/SCCmec IV/PVL-negative was prevalent amongst the colonising isolates, whereas ST59/PFGE type D/SCCmec V(T)/PVL-positive was prevalent amongst the clinical isolates. Evidence suggested that the ST59 CA-MRSA clone was not only circulating in Taiwan but also in other areas of the world. In this article, the current status of CA-MRSA in Taiwan was extensively reviewed. The information provided here is not only important for local public health but can also enhance a general understanding of the successful epidemic clones of CA-MRSA worldwide.
耐甲氧西林金黄色葡萄球菌（MRSA）自 20 世纪 90 年代末以来，已被越来越多地确定为先前健康宿主中社区获得性（CA）感染的主要原因。CA-MRSA 菌株被认为是一种新型病原体，与医疗保健相关的 MRSA 在基因上有所不同，并且在全球范围内已鉴定出五个主要的流行克隆。在台湾，过去十年中，健康受试者的 MRSA 携带和感染率呈显著上升趋势。高达 9.5%的健康台湾儿童鼻腔携带 MRSA，超过 50%的儿科 CA 金黄色葡萄球菌感染是 MRSA。成人也受到影响，但相对有限。台湾的大多数 CA-MRSA 分离株属于通过多位点序列分型（MLST）定义的序列型（ST）59 谱系，对非β-内酰胺类药物具有多重耐药性。ST59 谱系的克隆可通过脉冲场凝胶电泳（PFGE）分型、葡萄球菌染色体盒 mec（SCCmec）元件和杀白细胞素（PVL）基因进一步分为至少两个主要克隆。特征为 ST59/PFGE 型 C/SCCmec IV/PVL-阴性的克隆在定植分离株中较为普遍，而 ST59/PFGE 型 D/SCCmec V（T）/PVL-阳性的克隆在临床分离株中较为普遍。有证据表明，ST59 CA-MRSA 克隆不仅在台湾流行，而且在世界其他地区也流行。本文广泛回顾了台湾 CA-MRSA 的现状。这里提供的信息不仅对当地公共卫生很重要，而且可以增强对全球 CA-MRSA 成功流行克隆的一般了解。
