巴西胰岛素依赖型糖尿病患者中耐甲氧西林金黄色葡萄球菌的分子特征。
Molecular characterization of methicillin-resistant Staphylococcus aureus among insulin-dependent diabetic individuals in Brazil.
机构信息
Departamento de Infectologia, Dermatologia, Diagnóstico Por Imagem e Radioterapia, Faculdade de Medicina de Botucatu, UNESP - Universidade Estadual Paulista Júlio de Mesquita Filho, Botucatu, SP, Brasil.
Departamento de Ciências Químicas e Biológicas, Instituto de Biociências de Botucatu, UNESP - Universidade Estadual Paulista Júlio de Mesquita Filho, Botucatu, SP, Brasil.
出版信息
Ann Clin Microbiol Antimicrob. 2021 Feb 10;20(1):12. doi: 10.1186/s12941-020-00401-y.
BACKGROUND
People with diabetes mellitus, especially insulin-dependent diabetic patients, are a risk group for staphylococcal infections. Asymptomatic infection with Staphylococcus aureus is common and favors dissemination of the microorganism, rendering these individuals a source of infection. This study aimed to characterize the resistance profile, clonal profile and sequence type, as well as to analyze the prevalence and risk factors for nasal and oropharyngeal carriage of methicillin-susceptible (MSSA) and methicillin-resistant S. aureus (MRSA) isolated from insulin-dependent diabetic individuals in the city of Botucatu, SP, Brazil.
METHODS
Staphylococcus aureus was collected from the nasopharynx and oropharynx of 312 community-dwelling insulin-dependent diabetic individuals over a period of 3 years (October 2015 to December 2018). The isolates were characterized by susceptibility profiling, detection of the mecA gene, SCCmec typing, and molecular typing by PFGE and MLST. The risk factors associated with S. aureus and MRSA carriage were determined by logistic regression analysis.
RESULTS
The overall prevalence of colonization with S. aureus and MRSA was 30.4% and 4.8%, respectively. Fifteen of the 112 S. aureus isolates carried the mecA gene; SCCmec type IV was identified in 10 isolates, SCCmec type I in three, and SCCmec type II in two. Among the 15 resistant isolates (MRSA), four were susceptible to oxacillin/cefoxitin by the disc diffusion method and one MSSA isolate was resistant to sulfamethoxazole/trimethoprim. The analysis of risk factors revealed a protective effect of age and lung disease, while lower-extremity ulcers were a risk factor for S. aureus. For MRSA, only male gender was significantly associated as a risk factor in multivariate analysis. Clonal profile analysis demonstrated the formation of clusters among MRSA isolates from different patients, with the identification of ST5-IV, ST5-I, and ST8-IV. Isolates carrying ST398 were identified among MSSA and MRSA (ST398-IV).
CONCLUSION
Our findings reinforce the importance of epidemiological studies of S. aureus carriage, especially in populations at high risk of infections such as diabetics. The data suggest widespread dissemination of MRSA in the population of insulin-dependent diabetic patients studied, as well as the emergence of important lineages among these individuals.
背景
糖尿病患者，尤其是胰岛素依赖型糖尿病患者，是葡萄球菌感染的高危人群。金黄色葡萄球菌无症状感染较为常见，有利于微生物的传播，使这些个体成为感染源。本研究旨在对巴西博图卡图市的胰岛素依赖型糖尿病患者鼻腔和口咽分离的甲氧西林敏感金黄色葡萄球菌（MSSA）和甲氧西林耐药金黄色葡萄球菌（MRSA）的耐药谱、克隆谱和序列型进行特征描述，并分析其携带率和风险因素。
方法
在 3 年期间（2015 年 10 月至 2018 年 12 月），从 312 名居住在社区的胰岛素依赖型糖尿病患者的鼻咽和口咽采集了金黄色葡萄球菌。通过药敏试验、mecA 基因检测、SCCmec 分型、PFGE 和 MLST 分子分型对分离株进行鉴定。采用逻辑回归分析确定与金黄色葡萄球菌和 MRSA 携带相关的危险因素。
结果
金黄色葡萄球菌和 MRSA 总定植率分别为 30.4%和 4.8%。112 株金黄色葡萄球菌中有 15 株携带 mecA 基因，其中 10 株为 SCCmec 型 IV，3 株为 SCCmec 型 I，2 株为 SCCmec 型 II。在 15 株耐药分离株（MRSA）中，有 4 株对苯唑西林/头孢西丁纸片扩散法敏感，1 株 MSSA 对磺胺甲噁唑/甲氧苄啶耐药。多因素分析显示，年龄和肺部疾病有保护作用，而下肢溃疡是金黄色葡萄球菌的危险因素。对于 MRSA，仅男性是多因素分析中携带的危险因素。克隆谱分析显示，不同患者的 MRSA 分离株之间形成了簇，鉴定出 ST5-IV、ST5-I 和 ST8-IV。在 MSSA 和 MRSA（ST398-IV）中发现了携带 ST398 的分离株。
结论
本研究结果强调了金黄色葡萄球菌定植的流行病学研究的重要性，特别是在糖尿病等感染高危人群中。数据表明，在所研究的胰岛素依赖型糖尿病患者人群中，MRSA 的传播广泛，并且在这些个体中出现了重要的谱系。
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