Doudoulakakis A G, Bouras D, Drougka E, Kazantzi M, Michos A, Charisiadou A, Spiliopoulou I, Lebessi E, Tsolia M
Department of Microbiology, "P. & A. Aglaia Kyriakou" Children's Hospital, Athens, Greece.
Department of Microbiology, "Aghia Sophia" Children's Hospital, Athens, Greece.
Eur J Clin Microbiol Infect Dis. 2016 Jul;35(7):1177-85. doi: 10.1007/s10096-016-2651-7. Epub 2016 May 2.
Staphylococcus aureus is an infrequent cause of community-associated (CA-SA) pneumonia in children. The aim of this study was to evaluate the clinical, epidemiological, microbiological, and molecular characteristics of CA-SA pneumonia among children hospitalized in two large tertiary care referral centers during an 8-year period. Cases of CA-SA pneumonia admitted between 2007 and 2014 were retrospectively examined through medical record review. Molecular investigation was performed for available strains; mecA, Panton-Valentine leukocidin (PVL) (lukS-lukF-PV), and fibronectin binding protein A (fnbA) genes were detected by polymerase chain reaction (PCR). Clones were assigned by agr groups, pulsed-field gel electrophoresis (PFGE), SCCmec, and multilocus sequencing typing (MLST). In total, 41 cases were recorded (boys, 61 %), with a median age of 4.3 months (range, 1-175). Methicillin-resistant S. aureus (MRSA) accounted for 31 cases (75.6 %). Complications included empyema (25/41, 61 %), pneumatoceles (7/41, 17 %), and lung abscess (1/41, 2.5 %). Intensive care unit (ICU) admission was required in 58.5 %. Two deaths occurred (4.9 %). Definitive therapy was based on vancomycin with or without other antibiotics (55.9 %), followed by clindamycin and linezolid (26.5 % each). All isolates were susceptible to vancomycin (MIC90 2 mg/L, range 1-2), teicoplanin, and linezolid, whereas 26.8 % were resistant to clindamycin. Among the 25 studied strains, 20 were mecA-positive (MRSA), carrying also the fnbA gene. Of these, 90 % belonged to the ST80-IV/agr3/PVL-positive clone. Methicillin-susceptible S. aureus (MSSA) strains showed polyclonality, 3/5 were PVL-positive, and 3/5 were fnbA-positive. MRSA and particularly the ST80-IV clone predominated among staphylococcal pneumonia cases in children. Treatment provided was effective in all but two patients, despite the relatively high minimum inhibitory concentration (MIC) of vancomycin and a high resistance to clindamycin.
金黄色葡萄球菌是儿童社区获得性（CA-SA）肺炎的少见病因。本研究旨在评估8年间在两家大型三级医疗转诊中心住院的儿童CA-SA肺炎的临床、流行病学、微生物学及分子特征。通过病历回顾对2007年至2014年期间收治的CA-SA肺炎病例进行回顾性研究。对可得菌株进行分子研究；采用聚合酶链反应（PCR）检测mecA、杀白细胞素（PVL）（lukS-lukF-PV）和纤连蛋白结合蛋白A（fnbA）基因。通过葡萄球菌A蛋白（agr）分型、脉冲场凝胶电泳（PFGE）、葡萄球菌染色体盒式Mec（SCCmec）及多位点测序分型（MLST）对克隆进行分型。共记录41例病例（男孩占61%），中位年龄4.3个月（范围1 - 175个月）。耐甲氧西林金黄色葡萄球菌（MRSA）占31例（75.6%）。并发症包括脓胸（25/41，61%）、肺气囊（7/41，17%）和肺脓肿（1/41，2.5%）。58.5%的病例需要入住重症监护病房（ICU）。发生2例死亡（4.9%）。确切治疗以单用或联用其他抗生素的万古霉素为主（55.9%），其次是克林霉素和利奈唑胺（各占26.5%）。所有分离株对万古霉素（MIC90 2mg/L，范围1 - 2）、替考拉宁和利奈唑胺敏感，而26.8%对克林霉素耐药。在研究的25株菌株中，20株mecA阳性（MRSA），同时携带fnbA基因。其中，90%属于ST80-IV/agr3/PVL阳性克隆。甲氧西林敏感金黄色葡萄球菌（MSSA）菌株显示多克隆性，5株中有3株PVL阳性，5株中有3株fnbA阳性。MRSA尤其是ST80-IV克隆在儿童葡萄球菌肺炎病例中占主导。尽管万古霉素的最低抑菌浓度（MIC）相对较高且对克林霉素耐药，但除2例患者外，所提供的治疗对所有患者均有效。
