中国成人社区获得性肺炎患者呼吸道中社区获得性耐甲氧西林金黄色葡萄球菌的流行状况及分子特征。

Prevalence and molecular characteristics of community-associated methicillin-resistant Staphylococcus aureus in the respiratory tracts of Chinese adults with community-acquired pneumonia.

机构信息

Jiangsu Key Lab of Zoonosis/Jiangsu Co-Innovation Center for Prevention and Control of Important Animal Infectious Diseases and Zoonoses, Yangzhou University, China; Key Laboratory of Prevention and Control of Biological Hazard Factors (Animal Origin) for Agri-food Safety and Quality, Ministry of Agriculture of China, Yangzhou University, China.

出版信息

J Infect Public Health. 2023 May;16(5):713-718. doi: 10.1016/j.jiph.2023.03.014. Epub 2023 Mar 16.

DOI:10.1016/j.jiph.2023.03.014

PMID:36940498

Abstract

BACKGROUND

Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) is an important pathogen causing healthcare-associated infections. In recent years, an increasing number of CA-MRSA clones have emerged and rapidly spread in the community and hospital settings in China.

OBJECTIVES

To investigate the molecular epidemiology and resistance of CA-MRSA in the respiratory tracts of Chinese adults with community-acquired pneumonia (CAP).

METHODS

A total of 243 sputum samples were collected from adult patients with CAP at the Nantong Hospital in China between 2018 and 2021. S. aureus was identified using PCR, and its susceptibility to 14 antimicrobials was tested using the broth dilution method. Genomic characterization of respiratory CA-MRSA and our previously collected intestinal CA-MRSA isolates was performed using whole-genome sequencing, and the evolutionary relationships of these isolates were assessed using phylogenetic analysis.

RESULTS

The CA-MRSA colonization rate among adults with CAP in China was 7.8 % (19/243). Antimicrobial resistance analysis revealed that the proportion of multidrug-resistant respiratory CA-MRSA isolates (100 %) was higher than that of intestinal CA-MRSA isolates (6.3 %). Among the 35 CA-MRSA isolates, 10 MLST types were identified and clustered into five clone complexes (CCs). CC5 (48.6 %) and CC88 (20 %) were predominant CA-MRSA clones. Notably, the CC5 clone ST764/ST6292-MRSA-II-t002 was identified as the major lineage causing respiratory tract infections in Chinese adults with CAP.

CONCLUSIONS

The prevalence of CA-MRSA among Chinese adults with CAP is high and often involves ST764/ST6292-MRSA-II-t002 as the causal pathogen.

摘要

背景

社区相关性耐甲氧西林金黄色葡萄球菌（CA-MRSA）是一种引起医院获得性感染的重要病原体。近年来，越来越多的 CA-MRSA 克隆在中国的社区和医院环境中出现并迅速传播。

目的

调查中国成人社区获得性肺炎（CAP）呼吸道中 CA-MRSA 的分子流行病学和耐药性。

方法

2018 年至 2021 年，在中国南通医院共采集 243 例成人 CAP 患者的痰标本。采用 PCR 方法鉴定金黄色葡萄球菌，并采用肉汤稀释法检测其对 14 种抗菌药物的敏感性。采用全基因组测序对呼吸道 CA-MRSA 和我们之前收集的肠道 CA-MRSA 分离株进行基因组特征分析，并采用系统发育分析评估这些分离株的进化关系。

结果

中国成人 CAP 中 CA-MRSA 的定植率为 7.8%（19/243）。耐药性分析显示，耐多药呼吸道 CA-MRSA 分离株（100%）的比例高于肠道 CA-MRSA 分离株（6.3%）。在 35 株 CA-MRSA 分离株中，鉴定出 10 种 MLST 型，分为 5 个克隆复合体（CC）。CC5（48.6%）和 CC88（20%）是主要的 CA-MRSA 克隆。值得注意的是，CC5 克隆 ST764/ST6292-MRSA-II-t002 被确定为引起中国成人 CAP 患者呼吸道感染的主要谱系。