台湾北部成年患者中社区获得性与医疗保健相关耐甲氧西林金黄色葡萄球菌分离株的比较分子特征
Comparative Molecular Characteristics of Community-Associated and Healthcare-Associated Methicillin-Resistant Staphylococcus aureus Isolates From Adult Patients in Northern Taiwan.
作者信息
Chen Yi-Jen, Liu Kuan-Liang, Chen Chih-Jung, Huang Yhu-Chering
机构信息
From the Division of Pediatric infectious Disease, Department of Pediatrics (Y-JC, C-JC, Y-CH), Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital (K-LL); and Chang Gung University College of Medicine, Taoyuan, Taiwan (K-LL, C-JC, Y-CH).
出版信息
Medicine (Baltimore). 2015 Dec;94(49):e1961. doi: 10.1097/MD.0000000000001961.
Methicillin-resistant Staphylococcus aureus (MRSA) is an important nosocomial pathogen in hospitals, and increases rapidly in the community, named as community-associated MRSA (CA-MRSA). We conducted a prospective/retrospective study to understand the epidemiology, antimicrobial susceptibility, and molecular characteristics of MRSA infections in adult patients in Taiwan.From March to June, 2012, all clinical MRSA isolates were prospectively collected from adult patients in a tertiary hospital in northern Taiwan. Selective isolates were further characterized. We reviewed the detailed medical record of each case retrospectively.A total of 857 clinical isolates were collected from 555 patients. A total of 749 isolates from 453 patients were classified as healthcare-associated (HA)-MRSA and 108 isolates from 102 patients as CA-MRSA by the epidemiologic criteria. Compared to HA-MRSA, CA-MRSA isolates were significantly more frequently identified from pus (78% vs 28%, P < 0.001) and less frequently from sputum (4.6% vs 43.8%, P < 0.001) and blood (3.7% vs 15%, P = 0.002). CA-MRSA isolates were more susceptible to all antibiotics tested. A total of 102 CA-MRSA and 101 HA-MRSA isolates were characterized, showing significantly different molecular characteristics between CA and HA isolates (P < 0.001). The clone of sequence type (ST) 59/t437 complex, with 2 pulsotypes, accounted for 70% of CA isolates. Three major clones were identified from HA-MRSA isolates, namely clonal complex (CC) 59 (32.7%), CC239 (29.7%), and CC5 (24.8%). Among HA isolates, a significant difference was also seen between community-onset and hospital-onset MRSA isolates in terms of the source of specimens, antibiotic susceptibility patterns, and molecular characteristics.CA-MRSA isolates from adults in northern Taiwan were genetically significantly different from HA isolates. The community clones, CC59, spread into hospitals.
耐甲氧西林金黄色葡萄球菌（MRSA）是医院中一种重要的医院病原体，且在社区中迅速增加，被称为社区相关性MRSA（CA-MRSA）。我们进行了一项前瞻性/回顾性研究，以了解台湾成年患者中MRSA感染的流行病学、抗菌药物敏感性及分子特征。2012年3月至6月，前瞻性收集了台湾北部一家三级医院成年患者的所有临床MRSA分离株。对部分分离株进一步进行特征分析。我们回顾了每个病例的详细病历。共从555例患者中收集到857株临床分离株。根据流行病学标准，453例患者的749株分离株被分类为医疗保健相关（HA）-MRSA，102例患者的108株分离株被分类为CA-MRSA。与HA-MRSA相比，CA-MRSA分离株从脓液中分离出的频率显著更高（78%对28%，P<0.001），而从痰液（4.6%对43.8%，P<0.001）和血液（3.7%对15%，P=0.002）中分离出的频率显著更低。CA-MRSA分离株对所有测试抗生素更敏感。共对102株CA-MRSA和101株HA-MRSA分离株进行了特征分析，结果显示CA和HA分离株之间分子特征存在显著差异（P<0.001）。序列类型（ST）59/t437复合体的克隆，有2个脉冲型，占CA分离株的70%。从HA-MRSA分离株中鉴定出三个主要克隆，即克隆复合体（CC）59（32.7%）、CC239（29.7%）和CC5（24.8%）。在HA分离株中，社区发病和医院发病的MRSA分离株在标本来源、抗生素敏感性模式和分子特征方面也存在显著差异。台湾北部成年患者的CA-MRSA分离株在基因上与HA分离株有显著差异。社区克隆CC59传播到了医院。
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