From the Government Central Laboratories, Ministry of Health, Jerusalem, Israel.
Pediatric Infectious Disease Unit.
Pediatr Infect Dis J. 2019 Mar;38(3):230-235. doi: 10.1097/INF.0000000000002126.
Pediatric community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infections are emerging worldwide. High CA-MRSA carriage rates were previously described in healthy Bedouin children. We assessed demographic, clinical and molecular characteristics of pediatric MRSA infections in southern Israel.
The Soroka University Medical Center laboratory serves the entire population of southern Israel, divided into 2 ethnic groups, Bedouins and Jews. All in-hospital MRSA clinical isolates from children 0 to 18 years old obtained in 2016 were included. Health care-associated and community-associated infections were defined according to the Centers for Disease Control and Prevention case definition. All isolates were evaluated for staphylococcal cassette chromosome, Panton-Valentine leukocidin, S. aureus protein A type, pulsed field gel electrophoresis and antimicrobial susceptibility testing.
Overall, 95 MRSA isolates (18% of all S. aureus), with 25 different MRSA strains, were identified. Twenty-eight isolates (29.5% of MRSA) belonged to the pediatric clone, rarely observed in Israel, staphylococcal cassette chromosome IV, Panton-Valentine leukocidin positive, S. aureus protein A type 002. All isolates demonstrated identical pulsed-field-gel-electrophoresis fingerprints. Eighty-two percent of infections caused by this clone were community-acquired, mainly observed in young Bedouin children, causing skin and soft-tissue infections. The new clone infection characteristics were similar to those of other CA-MRSA. All isolates of the pediatric clone were susceptible to trimethoprim/sulfamethoxazole, ciprofloxacin, gentamicin, tetracycline, rifampicin and vancomycin; 17.8% were nonsusceptible to erythromycin and clindamycin.
The pediatric CA-MRSA clone, previously described only in sporadic cases in Israel, is emerging among healthy, young Bedouin children, typically causing skin and soft-tissue infections. Isolates are susceptible to a variety of non-beta-lactam antibiotics.
小儿社区相关性耐甲氧西林金黄色葡萄球菌（CA-MRSA）感染正在全球范围内出现。先前在健康的贝都因儿童中描述了高 CA-MRSA 携带率。我们评估了以色列南部儿科 MRSA 感染的人口统计学、临床和分子特征。
索罗卡大学医学中心实验室为以色列南部的全部人口提供服务，分为贝都因人和犹太人两个民族。2016 年从 0 至 18 岁住院的所有 MRSA 临床分离株均包括在内。根据疾病控制和预防中心的病例定义，定义了医源性和社区相关性感染。所有分离株均进行了葡萄球菌盒染色体、杀白细胞素 Panton-Valentine、金黄色葡萄球菌蛋白 A 型、脉冲场凝胶电泳和抗菌药物敏感性试验评估。
总体而言，共鉴定出 95 株（所有金黄色葡萄球菌的 18%）MRSA 分离株，其中 25 株为不同的 MRSA 菌株。28 株（MRSA 的 29.5%）属于儿科克隆，在以色列很少见，葡萄球菌盒染色体 IV，杀白细胞素 Panton-Valentine 阳性，金黄色葡萄球菌蛋白 A 型 002。所有分离株的脉冲场凝胶电泳指纹图谱完全相同。该克隆引起的 82%感染为社区获得性，主要见于年轻的贝都因儿童，引起皮肤和软组织感染。新克隆的感染特征与其他 CA-MRSA 相似。儿科克隆的所有分离株均对甲氧苄啶/磺胺甲恶唑、环丙沙星、庆大霉素、四环素、利福平、万古霉素敏感；17.8%对红霉素和克林霉素不敏感。
在以色列以前仅在散发病例中描述的儿科 CA-MRSA 克隆，正在健康的年轻贝都因儿童中出现，通常引起皮肤和软组织感染。分离株对多种非β-内酰胺类抗生素敏感。
