中国新生儿重症监护病房新生儿金黄色葡萄球菌定植的流行病学研究。
Epidemiology of Staphylococcus aureus in neonates on admission to a Chinese neonatal intensive care unit.
机构信息
Neonatal Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China.
Respiratory Department, Qilu Children's Hospital of Shandong University, Jinan, China.
出版信息
PLoS One. 2020 Feb 13;15(2):e0211845. doi: 10.1371/journal.pone.0211845. eCollection 2020.
PURPOSE
Little is known about the molecular epidemiology of Staphylococcus aureus in Chinese neonatal intensive care units (NICUs). We describe the molecular epidemiology of S. aureus isolated from neonates on admission to Beijing Children's Hospital.
METHODS
From May 2015-March 2016, nasal swabs were obtained on admission from 536 neonates. Cultures were also obtained from body sites with suspected infections. S. aureus isolates were characterized by staphylococcal chromosomal cassette (SCCmec) type, staphylococcal protein A (spa) type, multilocus sequence type (MLST), sasX gene, antimicrobial susceptibility and cytotoxicity. Logistic regression assessed risk factors for colonization.
RESULTS
Overall, 92 (17%) infants were colonized with S. aureus and 20 (3.7%) were diagnosed with culture-positive S. aureus infection. Of the colonized infants, 70% (64/92) harbored methicillin-susceptible S. aureus (MSSA), 30% (28/92) harbored methicillin-resistant S. aureus (MRSA) while 70% (14/20) of infected infants were culture-positive for MRSA, 30% (6/20) were culture-positive for MSSA. Risk factors for colonization included female sex, age 7-28 days, higher birthweight (3270 IQR [2020-3655] grams) and vaginal delivery (p<0.05). The most common MRSA and MSSA clones were community-associated ST59-SCCmecIVa-t437 (60%) and ST188-t189 (15%), respectively. The sasX gene was not detected. Some MSSA isolates (16%) were penicillin-susceptible and some MRSA isolates (18%) were oxacillin-susceptible. MRSA and MSSA had similar cytotoxicity, but colonizing strains were less cytotoxic than strains associated with infections.
CONCLUSIONS
S. aureus colonization was common in infants admitted to our NICU and two community-associated clones predominated. Several non-modifiable risk factors for S. aureus colonization were identified. These results suggest that screening infants for S. aureus upon admission and targeting decolonization of high-risk infants and/or those colonized with high-risk clones could be useful to prevent transmission.
目的
关于中国新生儿重症监护病房（NICU）中金黄色葡萄球菌的分子流行病学知之甚少。我们描述了在北京儿童医院入院的新生儿中分离的金黄色葡萄球菌的分子流行病学。
方法
2015 年 5 月至 2016 年 3 月，从 536 名新生儿入院时采集鼻拭子。还从疑似感染部位采集培养物。通过葡萄球菌染色体盒（SCCmec）型、葡萄球菌蛋白 A（spa）型、多位点序列型（MLST）、sasX 基因、抗菌药物敏感性和细胞毒性来描述金黄色葡萄球菌分离株的特征。逻辑回归评估定植的危险因素。
结果
总体而言，92 名（17%）婴儿定植了金黄色葡萄球菌，20 名（3.7%）婴儿确诊为金黄色葡萄球菌感染。定植婴儿中，70%（64/92）携带耐甲氧西林金黄色葡萄球菌（MSSA），30%（28/92）携带耐甲氧西林金黄色葡萄球菌（MRSA），20 名感染婴儿中，70%（14/20）为 MRSA 培养阳性，30%（6/20）为 MSSA 培养阳性。定植的危险因素包括女性、7-28 天龄、较高的出生体重（3270 IQR [2020-3655] 克）和阴道分娩（p<0.05）。最常见的 MRSA 和 MSSA 克隆分别为社区相关 ST59-SCCmecIVa-t437（60%）和 ST188-t189（15%）。未检测到 sasX 基因。一些 MSSA 分离株（16%）对青霉素敏感，一些 MRSA 分离株（18%）对苯唑西林敏感。MRSA 和 MSSA 的细胞毒性相似，但定植株的细胞毒性低于与感染相关的菌株。
结论
我们 NICU 入院的婴儿金黄色葡萄球菌定植很常见，两种社区相关克隆占主导地位。确定了几个金黄色葡萄球菌定植的不可改变的危险因素。这些结果表明，在入院时对婴儿进行金黄色葡萄球菌筛查，并针对定植高危婴儿和/或定植高危克隆的婴儿进行去定植，可能有助于预防传播。
Zotero 插件