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医院传播的耐甲氧西林金黄色葡萄球菌阳性克隆复合体5(CC5)

Hospital Dissemination of -Positive Clonal Complex 5 (CC5) Methicillin-Resistant .

作者信息

Wang Min, Zheng Yi, Mediavilla Jose R, Chen Liang, Kreiswirth Barry N, Song Yajun, Yang Ruifu, Du Hong

机构信息

State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and EpidemiologyBeijing, China.

Clinical Laboratory, The Second Affiliated Hospital of Soochow UniversitySuzhou, China.

出版信息

Front Cell Infect Microbiol. 2017 Mar 31;7:101. doi: 10.3389/fcimb.2017.00101. eCollection 2017.

Abstract

Methicillin-resistant (MRSA), is one of the most prevalent clinical pathogens isolated from hospital settings, and has increasingly identified in community settings. In China, the SCCIII-ST239 strains are disseminated in different geographic regions, accounting for >75% of all MRSA isolates in some national studies. Here we characterized 150 non-duplicate MRSA isolates collected from February 2012 to May 2013 in a tertiary hospital in Suzhou, Eastern China, to explore the molecular epidemiology. All isolates were characterized by typing, SCC typing, and detection of genes encoding Panton-Valentine leukocidin (PVL) and toxic shock syndrome toxin (TSST-1). Representative genotypes were also subjected to multilocus sequence typing (MLST). Antibiotic susceptibility testing was performed using BD Phoenix™ Automated Microbiology System. Molecular typing identified 11 clonal complex (CC) and 28 types, with the CC5- t002 (29.3%) and CC239- t037 (14.7%) being the most prevalent. SCC types II, III, IV, and V were identified in 33.3, 21.3, 23.3, and 21.3% of all isolates, respectively. PVL genes () were detected in 11.3% of all isolates and from 6 CCs (5, 8, 59, 88, 239, and 398). The TSST-1 gene () was detected in 18.0% of the all isolates, predominantly in CC5 (96.3%). All the -positve CC5 isolates were t002. Eighteen patients died within 30 days of hospitalization, and the in-hospital 30-day mortality was 12.0%. Multivariable analysis showed that 60 years old (odds ratio [OR] = 7.2, = 0.026), cancer diagnosis (OR = 9.6, = 0.022), and MRSA isolate carriage of (OR = 62.5, < 0.001) were independent factors associated with 30-day mortality. Our study revealed unique MRSA dissemination patterns in our hospital in comparison to those of other regions in China. The finding that -positive CC5 strains were associated with higher mortality highlights the need for strict infection control measures in order to prevent further spread of these strains in our hospital, as well as others.

摘要

耐甲氧西林金黄色葡萄球菌(MRSA)是医院环境中分离出的最常见临床病原体之一,且在社区环境中也越来越多地被发现。在中国,SCCIII-ST239菌株在不同地理区域传播,在一些全国性研究中占所有MRSA分离株的75%以上。在此,我们对2012年2月至2013年5月在中国东部苏州一家三级医院收集的150株非重复MRSA分离株进行了特征分析,以探索分子流行病学。所有分离株通过分型、SCC分型以及编码杀白细胞素(PVL)和毒性休克综合征毒素(TSST-1)的基因检测进行特征分析。代表性基因型还进行了多位点序列分型(MLST)。使用BD Phoenix™自动化微生物系统进行抗生素敏感性测试。分子分型鉴定出11个克隆复合体(CC)和28种类型,其中CC5-t002(29.3%)和CC239-t037(14.7%)最为常见。SCC II、III、IV和V型分别在所有分离株的33.3%、21.3%、23.3%和21.3%中被鉴定出来。PVL基因在所有分离株的11.3%中被检测到,来自6个CC(5、8、59、88、239和398)。TSST-1基因在所有分离株的18.0%中被检测到,主要在CC5(96.3%)中。所有携带TSST-1的CC5分离株均为t002型。18名患者在住院30天内死亡,院内30天死亡率为12.0%。多变量分析显示,年龄≥60岁(比值比[OR]=7.2,P=0.026)、癌症诊断(OR=9.6,P=0.022)以及携带TSST-1的MRSA分离株(OR=62.5,P<0.001)是与30天死亡率相关的独立因素。我们的研究揭示了我院与中国其他地区相比独特的MRSA传播模式。携带TSST-1的CC5菌株与较高死亡率相关这一发现凸显了采取严格感染控制措施的必要性,以防止这些菌株在我院及其他医院进一步传播。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a84e/5374150/53c524a2753e/fcimb-07-00101-g0001.jpg

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