Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Republic of Korea.
Department of Pediatrics, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea.
Microb Drug Resist. 2018 Dec;24(10):1552-1558. doi: 10.1089/mdr.2017.0224. Epub 2018 Nov 20.
sequence type (ST) 131 has emerged as a higher virulent and multidrug-resistant pathogen worldwide. This study aimed to identify the prevalence and characteristics of ST131 isolated from Korean children with bacteremia at a single center for 16 years. We retrospectively reviewed culture-proven bacteremia cases of children aged ≤18 years between 2000 and 2015. isolates were analyzed using multilocus sequence typing, typing, and CTX-M typing. Among 177 children with bacteremia, a total of 21 (11.9%) ST131 isolates and 37 (20.9%) extended spectrum β-lactamase (ESBL)-producing were identified. Nineteen (90.5%) isolates of ST131 had the gene, of which three were assigned to subclone H30. There was a significant difference in prevalence of ESBL production between ST131 ( = 8, 38.1%) and non-ST131 ( = 29, 18.6%) isolates ( = 0.039). Five ESBL-producing ST131 isolates had the gene: two carried , two carried , and one carried both and . ST131 isolates had higher resistance rates to piperacillin/tazobactam (38.5% vs. 10.0%), cefotaxime (38.1% vs. 16.7%), amikacin (23.8% vs. 1.9%), and gentamicin (52.4% vs. 28.8%) than non-ST131 isolates ( < 0.05, for all). There were no significant differences in the rate of shock and mortality between patients infected with ST131 (16.7% and 5.6%) and non-ST131 isolates (24.2% and 9.8%). Prevalence of ST131 causing bacteremia in children was not different from that in adults or that causing urinary tract infection in children in Korea. However, because ST131 clones are more likely to be ESBL producing and more resistant to empirical antibiotics used in sepsis than are non-ST131 clones, surveillance for the prevalence of ST131 and its drug resistance should be continued.
序列型 131（ST131）已成为全球具有更高毒力和多重耐药性的病原体。本研究旨在确定在一家单中心 16 年间，从韩国患有菌血症的儿童中分离出的 ST131 的流行率和特征。我们回顾性分析了 2000 年至 2015 年间年龄≤18 岁的培养阳性菌血症患儿的病例。采用多位点序列分型、CTX-M 分型和 分型对 进行分析。在 177 例菌血症患儿中，共分离出 21 株（11.9%）ST131 株和 37 株（20.9%）产超广谱β-内酰胺酶（ESBL） 。19 株（90.5%）ST131 携带 基因，其中 3 株被归为亚克隆 H30。ST131（=8，38.1%）和非 ST131（=29，18.6%）分离株产 ESBL 的比例有显著差异（=0.039）。5 株产 ESBL 的 ST131 携带 基因：2 株携带 ，2 株携带 ，1 株同时携带 和 。与非 ST131 分离株相比，ST131 分离株对哌拉西林/他唑巴坦（38.5%对 10.0%）、头孢噻肟（38.1%对 16.7%）、阿米卡星（23.8%对 1.9%）和庆大霉素（52.4%对 28.8%）的耐药率更高（<0.05，均）。感染 ST131（16.7%和 5.6%）和非 ST131 分离株（24.2%和 9.8%）的患儿休克和死亡率无显著差异。韩国儿童菌血症的 ST131 发生率与成人或儿童尿路感染的发生率无差异。然而，由于 ST131 克隆比非 ST131 克隆更有可能产生 ESBL，并且对脓毒症中使用的经验性抗生素更耐药，因此应继续监测 ST131 的流行率及其耐药性。
