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耐甲氧西林金黄色葡萄球菌的克隆谱系 ST5-SCCmecII-t2460 与武汉一家医院的高死亡率有关。

Methicillin-resistant Staphylococcus aureus of the clonal lineage ST5-SCCmecII-t2460 was associated with high mortality in a Wuhan hospital.

机构信息

Department of Laboratory Medicine, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, China.

Department of Laboratory Medicine, Beijing Haidian Maternal and Child Health Hospital, Beijing, China.

出版信息

Braz J Microbiol. 2021 Dec;52(4):1929-1936. doi: 10.1007/s42770-021-00557-5. Epub 2021 Jul 8.

Abstract

Methicillin-resistant Staphylococcus aureus (MRSA) is an important human pathogen that can cause serious infectious diseases. An emerging MRSA strain, ST5-SCCmecII spa-type-t2460 (SMRSA), has spread rapidly since its recent emergence in China, but little information is available about this lineage. In this study, 91 MRSA isolates were collected from patients treated in the Zhongnan Hospital, Wuhan University, from 2018 to 2019, and investigated for their molecular characteristics, antibiotic resistance profiles, and clinical characteristics. The predominant lineage, SMRSA, accounted for 37.4% (34/91) of the isolates, followed by ST239-SCCmecIII-t030 (19.8%, 18/91) and ST59-SCCmecIV-t437 (8.8%, 8/91). In contrast to the latter two non-SMRSA (nSMRSA) lineages, which are among the main MRSA found in Chinese settings, SMRSA exhibited small colony variant (SCV) phenotype and had extremely high resistance rates to erythromycin (100.0%), clindamycin (100.0%), levofloxacin (100.0%), tetracycline (97.1%), moxifloxacin (97.1%), and ciprofloxacin (100%), but was more susceptible to rifampicin (resistance rate 3%). The levels of white blood cells (WBC) and procalcitonin (PCT) and the 30-day mortality in patients infected with SMRSA were (12.54 ± 6.61) × 10/L, 0.66 ng/mL, and 52.9%, respectively, which were much higher than those in patients infected with nSMRSA. In addition, patients infected with SMRSA were more frequently admitted to the intensive care unit (ICU) and submitted to invasive procedures than those infected with nSMRSA. In conclusion, SMRSA showed SCV phenotype and exhibited multiple antibiotic-resistance profiles. In this study, SMRSA was associated with serious infections and poor prognosis. Compared with ST239, ST59, or other nSMRSA strains, patients infected with SMRSA strains have higher 30-day mortality, increased levels of inflammatory biomarkers, and more frequent ICU hospitalization and invasive procedures.

摘要

耐甲氧西林金黄色葡萄球菌(MRSA)是一种重要的人类病原体,可导致严重的传染病。一种新兴的 MRSA 菌株 ST5-SCCmecII spa-type-t2460(SMRSA)在中国出现后迅速传播,但有关该谱系的信息很少。本研究从 2018 年至 2019 年在武汉大学中南医院接受治疗的患者中收集了 91 株 MRSA 分离株,对其分子特征、抗生素耐药谱和临床特征进行了调查。主要谱系 SMRSA 占分离株的 37.4%(34/91),其次是 ST239-SCCmecIII-t030(19.8%,18/91)和 ST59-SCCmecIV-t437(8.8%,8/91)。与后两种非 SMRSA(nSMRSA)谱系形成鲜明对比的是,SMRSA 表现出小菌落变异(SCV)表型,对红霉素(100.0%)、克林霉素(100.0%)、左氧氟沙星(100.0%)、四环素(97.1%)、莫西沙星(97.1%)和环丙沙星(100%)具有极高的耐药率,但对利福平(耐药率为 3%)更敏感。感染 SMRSA 的患者的白细胞(WBC)和降钙素原(PCT)水平和 30 天死亡率分别为(12.54±6.61)×10/L、0.66ng/mL 和 52.9%,均明显高于感染 nSMRSA 的患者。此外,与感染 nSMRSA 的患者相比,感染 SMRSA 的患者更频繁地入住重症监护病房(ICU)并接受侵入性操作。总之,SMRSA 表现出 SCV 表型并表现出多种抗生素耐药谱。在本研究中,SMRSA 与严重感染和不良预后相关。与 ST239、ST59 或其他 nSMRSA 菌株相比,感染 SMRSA 菌株的患者 30 天死亡率更高,炎症生物标志物水平更高,ICU 住院和侵入性操作更频繁。

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