Harik Nada S, Com Gulnur, Tang Xinyu, Melguizo Castro Maria, Stemper Mary E, Carroll John L
Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR.
Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR.
Am J Infect Control. 2016 Apr 1;44(4):409-15. doi: 10.1016/j.ajic.2015.10.015. Epub 2015 Dec 9.
We describe the clinical characteristics and epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) in children with cystic fibrosis (CF) from the U.S. CF center with the highest MRSA prevalence.
Medical records of children with CF were retrospectively reviewed from 1997-2009. MRSA clinical isolates from 2007-2009 were analyzed by polymerase chain reaction and pulsed field gel electrophoresis.
The prevalence of MRSA was 1% in 1997 and 49% in 2009. Fifty-five children (26%) had persistent MRSA infection. Sixty-eight percent of MRSA isolates were hospital-associated (HA) MRSA, of which 52% were pulsed-field type USA 100. Ninety-three percent of HA MRSA isolates were clindamycin resistant. Twelve children acquired MRSA before 1 year of age, 83% of whom were hospitalized prior to acquisition of MRSA. Ten of 11 sibling pairs carried indistinguishable MRSA strains. Children with persistent MRSA were hospitalized more often (P = .01), required inhaled medications more frequently (P = .01), and had higher rates of Pseudomonas aeruginosa coinfection (P < .001).
MRSA prevalence in children with CF is increasing, and most children are infected with HA MRSA. Exposure to health care facilities and gastrointestinal surgeries may facilitate early acquisition of MRSA. Siblings carry indistinguishable MRSA strains, indicating household transmission of MRSA. Children with persistent MRSA had worse pulmonary morbidity. Coinfection with MRSA and P aeruginosa is likely associated with further increased pulmonary morbidity.
我们描述了来自美国耐甲氧西林金黄色葡萄球菌（MRSA）患病率最高的囊性纤维化（CF）中心的儿童MRSA的临床特征和流行病学情况。
回顾性分析了1997年至2009年CF患儿的病历。对2007年至2009年的MRSA临床分离株进行聚合酶链反应和脉冲场凝胶电泳分析。
1997年MRSA患病率为1%，2009年为49%。55名儿童（26%）患有持续性MRSA感染。68%的MRSA分离株为医院相关（HA）MRSA，其中52%为脉冲场型USA 100。93%的HA MRSA分离株对克林霉素耐药。12名儿童在1岁前感染了MRSA，其中83%在感染MRSA之前曾住院治疗。11对同胞中有10对携带难以区分的MRSA菌株。患有持续性MRSA的儿童住院频率更高（P = 0.01），更频繁需要吸入药物治疗（P = 0.01），且铜绿假单胞菌合并感染率更高（P < 0.001）。
CF患儿中MRSA患病率在增加，且大多数儿童感染的是HA MRSA。接触医疗保健机构和进行胃肠道手术可能有助于早期感染MRSA。同胞携带难以区分的MRSA菌株，表明MRSA可在家庭中传播。患有持续性MRSA的儿童肺部发病率更高。MRSA与铜绿假单胞菌合并感染可能与肺部发病率进一步升高有关。
