社区相关、甲氧西林敏感感染在住院儿童和青少年中占优势。
Predominance of community-associated, methicillin-susceptible infections among hospitalized children and adolescents.
机构信息
Department of Paediatrics, School of Medicine, University of Crete, Heraklion, Greece.
National Reference Laboratory for Staphylococci, School of Medicine, University of Patras, Patras, Greece.
出版信息
J Med Microbiol. 2022 Mar;71(3). doi: 10.1099/jmm.0.001511.
infections cause significant morbidity and mortality in children and adolescents. There is limited data on the characteristics of infections requiring hospitalization in childhood.To investigate the molecular epidemiology and antibiotic resistance of clinical isolates from children and adolescents.All isolates recovered from patients aged <18 years, admitted to a referral hospital, with culture-proven invasive or non-invasive infections during the 4 year period 2015 to 2018 were analysed for antimicrobial resistance, virulence genes, PFGE and multilocus sequence typing (MLST). Cases were assigned to community-associated, community-onset healthcare-associated or hospital-associated infections based on epidemiological case definitions.Among 139 infections, 88.5 % (123/139) were caused by methicillin-susceptible isolates (MSSA) and 73.4 % (102/139) were classified as community-associated infections. and genes were more common among MRSA as compared to MSSA isolates ( p 0.04; p 0.007). Invasive disease was noted in 22/139 patients (15.8 %). Staphylococcal scalded skin syndrome caused by fusidic-resistant MSSA increased over time (22.8 % in 2017-2018 vs 8.3 % in 2015-2016, OR 3.24; 95 % CI 1.10-8.36; 0.03). By PFGE genotyping, 22 pulsotypes were identified. A total of five sequence types (STs) were identified among 58 isolates analysed by MLST. More than one third of MSSA isolates (40/123, 32.5 %) and 13/23 (56.5 %) of SSSS isolates belonged to pulsotype 1, classified as sequence type 121 (ST121). MRSA isolates were equally distributed to pulsotypes A (ST30), B (ST239), C (ST80), H (ST225). ST121 isolates carried (40/40), genes (29/40), exhibited high resistance to fusidic acid and were increasingly resistant to mupirocin.In our population, community-associated MSSA was the predominant cause of infections characterized by polyclonality, increasing resistance to fusidic acid and mupirocin. PFGE type 1 ST121 clone, harboured exfoliative toxin genes and was associated with rising trends of SSSS.
感染可导致儿童和青少年发生严重的发病率和死亡率。目前关于儿童需要住院治疗的感染的特征的数据有限。本研究旨在调查儿童和青少年临床分离株的分子流行病学和抗生素耐药性。
对 2015 年至 2018 年期间在一家转诊医院住院、经培养证实患有侵袭性或非侵袭性感染的年龄<18 岁患者分离的所有 139 株感染株进行了抗生素耐药性、毒力基因、PFGE 和多位点序列分型（MLST）分析。根据流行病学病例定义，将病例分为社区相关性、社区发病的医疗机构相关或医院相关性感染。
在 139 例感染中，88.5%（123/139）由耐甲氧西林金黄色葡萄球菌（MSSA）引起，73.4%（102/139）为社区相关性感染。与 MSSA 分离株相比，MRSA 中更常见 和 基因（ p 0.04； p 0.007）。139 例患者中有 22 例（15.8%）发生侵袭性疾病。由耐药性福西地酸的 MSSA 引起的葡萄球菌性烫伤样皮肤综合征随时间增加（2017-2018 年为 22.8%，2015-2016 年为 8.3%，OR 3.24；95%CI 1.10-8.36； 0.03）。通过 PFGE 基因分型，鉴定出 22 种脉冲场凝胶电泳型。通过 MLST 分析的 58 株分离株共鉴定出 5 种序列型（ST）。超过三分之一的 MSSA 分离株（40/123，32.5%）和 23 株 SSSS 分离株中的 13 株（56.5%）属于脉冲场凝胶电泳型 1，被归类为序列型 121（ST121）。MRSA 分离株均匀分布于 A 型（ST30）、B 型（ST239）、C 型（ST80）、H 型（ST225）。ST121 分离株携带 （40/40）、 基因（29/40），对福西地酸表现出高度耐药性，并且对莫匹罗星的耐药性逐渐增加。在我们的人群中，社区相关性 MSSA 是引起感染的主要原因，其特征为多克隆性，对福西地酸和莫匹罗星的耐药性增加。携带 基因的 PFGE 型 1 ST121 克隆与剥脱性毒素基因有关，与 SSSS 的上升趋势有关。
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