从住院儿科患者中分离的金黄色葡萄球菌菌株的流行病学和分子特征。
Epidemiologic and Molecular Characteristics of Staphylococcus aureus Strains Isolated From Hospitalized Pediatric Patients.
机构信息
From the Department of Pediatric Infectious Diseases, Health Sciences University, Izmir Behcet Uz Children's Hospital.
Department of Pediatric Infectious Diseases, Health Sciences University, Izmir Tepecik Research and Training Hospital, Izmir.
出版信息
Pediatr Infect Dis J. 2020 Nov;39(11):1002-1006. doi: 10.1097/INF.0000000000002764.
BACKGROUND
We aimed to determine molecular characteristics of Staphylococcus aureus isolates cultured from hospitalized pediatric patients.
METHODS
All accessible S. aureus isolates cultured from hospitalized pediatric patients were analyzed for staphylococcal cassette chromosome mec (SCCmec) types, Panton-Valentine Leukocidin (PVL) encoding genes and antibiotic resistance patterns.
RESULTS
A total of 132 S. aureus isolates, 102 methicillin-susceptible S. aureus (MSSA) (81.8%), 30 methicillin-resistant S. aureus (MRSA) (18.2%) were included in the study. Sixty of 132 (45.5%) S. aureus isolates were cultured from skin and soft tissue infections (SSTIs), 50 (37.9%) from bloodstream infections, 11 (8.3%) from bone infections and 11 (8.3%) from other sterile sites. Fifty-three of 102 (52%) MSSA isolates were cultured from SSTI, 35 (34.3%) from bloodstream infections, 7 (6.9%) from bone infections and 7 (6.9%) from other sterile sites (P = 0.083). Fifteen MRSA isolates (50%) were cultured from blood culture, 7 from (23.3%) SSTI, 4 (13.3%) from bone infections and 4 from (13.3%) other sterile sites. Nine PVL gene harboring S. aureus isolates were isolated from SSTI (75%), 2 from blood culture (16.7%) and 1 from other sterile site (8.3%). Three MRSA (6.7%) isolates were found to be positive for SCCmec type III and 16 MRSA isolates (53.3%) were found to be positive for SCCmec type IV. Three MRSA isolates harboring SCCmec type III was isolated from blood culture, 11 of 16 MRSA isolates harboring SCCmec type IV was isolated from blood culture, 3 isolates were isolated from bone infections and 2 isolates were isolated from SSTI (P < 0.001). Five of 72 (6.9%) hospital-acquired S. aureus isolates and 7 of 60 (11.7%) community-acquired S. aureus isolates were PVL gene positive. Twenty-two of 72 (30.6%) hospital-acquired S. aureus infections and 8 of 60 (13.3%) community-acquired S. aureus isolates were MRSA (P = 0.015). All of the 3 SCCmec III harboring MRSA isolates and 11 of 16 SCCmec IV carrying MRSA isolates were hospital acquired. Hospitalization in the past 1 year was found to increase MRSA infections 3.95 times (P = 0.038, 95% confidence interval: 1.078-14.48).
CONCLUSIONS
As distribution of virulence genes differs among S. aureus isolates from different regions, it is necessary to monitor the emergence of genes encoding PVL, SCCmec in both MRSA and MSSA throughout the world. Our results show a high prevalence of PVL in community-onset S. aureus infections in children. SCCmec type IV was more commonly isolated in hospital-acquired MRSA isolates, and PVL gene was more commonly isolated in community-acquired S. aureus infections.
背景
我们旨在确定从住院儿科患者中分离的金黄色葡萄球菌的分子特征。
方法
对从住院儿科患者中分离的所有金黄色葡萄球菌进行分析，以确定葡萄球菌盒染色体 mec（SCCmec）类型、杀伤白细胞素（PVL）编码基因和抗生素耐药模式。
结果
共纳入 132 株金黄色葡萄球菌，其中甲氧西林敏感金黄色葡萄球菌（MSSA）102 株（81.8%），甲氧西林耐药金黄色葡萄球菌（MRSA）30 株（18.2%）。132 株金黄色葡萄球菌中，60 株（45.5%）分离自皮肤和软组织感染（SSTIs），50 株（37.9%）分离自血流感染，11 株（8.3%）分离自骨感染，11 株（8.3%）分离自其他无菌部位。53 株（52%）MSSA 分离株来自 SSTI，35 株（34.3%）来自血流感染，7 株（6.9%）来自骨感染，7 株（6.9%）来自其他无菌部位（P=0.083）。15 株 MRSA 分离株（50%）来自血培养，7 株（23.3%）来自 SSTI，4 株（13.3%）来自骨感染，4 株（13.3%）来自其他无菌部位。从 SSTI 中分离到 9 株携带 PVL 基因的金黄色葡萄球菌（75%），从血培养中分离到 2 株（16.7%），从其他无菌部位分离到 1 株（8.3%）。3 株（6.7%）MRSA 分离株被发现携带 SCCmec 型 III，16 株（53.3%）MRSA 分离株被发现携带 SCCmec 型 IV。3 株携带 SCCmec 型 III 的 MRSA 分离株来自血培养，16 株携带 SCCmec 型 IV 的 MRSA 分离株中有 11 株来自血培养，3 株来自骨感染，2 株来自 SSTI（P<0.001）。72 株（6.9%）医院获得性金黄色葡萄球菌分离株和 60 株（11.7%）社区获得性金黄色葡萄球菌分离株中有 7 株为 PVL 基因阳性。72 株（30.6%）医院获得性金黄色葡萄球菌感染和 8 株（13.3%）社区获得性金黄色葡萄球菌感染为 MRSA（P=0.015）。所有携带 SCCmec III 的 3 株 MRSA 分离株和携带 SCCmec IV 的 11 株 MRSA 分离株均为医院获得性。过去 1 年住院治疗使 MRSA 感染的风险增加 3.95 倍（P=0.038，95%置信区间：1.078-14.48）。
结论
由于不同地区金黄色葡萄球菌分离株的毒力基因分布不同，有必要在世界各地监测 MRSA 和 MSSA 中编码 PVL、SCCmec 的基因的出现情况。我们的结果显示，社区获得性金黄色葡萄球菌感染中携带 PVL 的儿童发病率较高。SCCmec 型 IV 更常见于医院获得性 MRSA 分离株，而 PVL 基因更常见于社区获得性金黄色葡萄球菌感染。
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