Department of Dermatology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China.
Department of Dermatology, Children's Hospital Affiliated to Capital Institute of Pediatrics, Beijing, China.
Front Cell Infect Microbiol. 2023 Jul 13;13:1179509. doi: 10.3389/fcimb.2023.1179509. eCollection 2023.
Skin and Soft Tissue Infections (SSTIs) Surveillance Network of In Pediatrics in China was established in 2009 to routinely report epidemiological changes. We aimed to monitor the present antibiotic sensitivity and molecular characteristics of and methicillin-resistant (MRSA) from SSTIs in children nationwide and track the changes over the past decade.
Patients diagnosed with SSTIs from the dermatology departments of 22 tertiary pediatric hospitals in seven geographical regions of China were recruited continuously from May 2019 to August 2021. was isolated, and its sensitivity to 15 antimicrobials was evaluated using the broth microdilution method. The molecular characteristics of the MRSA isolates were determined through multilocus sequence typing (MLST) and staphylococcal cassette chromosome (SCC) typing. The presence of the Panton-Valentine leukocidin gene () was determined.
The detection rate of was 62.57% (1379/2204), among which MRSA accounted for 14.79% (204/1379), significantly higher than the result in previous study in 2009-2011 (2.58%, 44/1075). Compared with previous study, the sensitivity to cephalosporins and fusidic acid decreased to varying degrees, while that to chloramphenicol, ciprofloxacin, clindamycin, erythromycin, gentamicin, penicillin, and tetracycline increased significantly. The sensitivity to mupirocin, trimethoprim/sulfamethoxazole (TRISUL), and rifampicin still maintained at a high level (97.90%, 99.35% and 96.66% respectively). The leading multidrug resistance pattern of MRSA and methicillin-sensitive (MSSA) were erythromycin-clindamycin-tetracycline (55.84%; 43/77) and erythromycin-clindamycin-chloramphenicol (27.85%, 44/158) respectively. 12 high-level mupirocin-resistant strains were detected, and notable differences in geographical distribution and seasonal variation were observed. The main types of MRSA were ST121 (46.08%, 94/204), followed by ST59 (19.61%, 40/204). SCC V (65.69%, 134/204) and SCC IV (31.86%, 65/204) were dominant epidemic types. ST121-V, ST59-IV, and ST22-V were the most prevalent clones nationwide. The detection rate of had increased markedly from 9.09% (4/44) in 2009-2011 to 22.55% (46/204) in 2019-2021 (P<0.05).
The antibiotic sensitivity and molecular characteristics of from pediatric SSTIs has changed significantly over the past decade. To standardize medical care, provide timely and reasonable clinical treatment, and effectively manage infection control, Chinese pediatric SSTIs guidelines are urgently needed.
中国儿科皮肤及软组织感染监测网络于 2009 年成立，旨在常规报告流行病学变化。本研究旨在监测全国儿童皮肤软组织感染（SSTIs）中 和耐甲氧西林金黄色葡萄球菌（MRSA）的目前抗生素敏感性和分子特征，并跟踪过去十年的变化。
连续招募 2019 年 5 月至 2021 年 8 月来自中国七个地理区域的 22 家三级儿科医院皮肤科诊断为 SSTIs 的患者。通过肉汤微量稀释法评估 对 15 种抗菌药物的敏感性。通过多位点序列分型（MLST）和葡萄球菌盒式染色体（SCC）分型确定 MRSA 分离株的分子特征。通过检测 Panton-Valentine 白细胞毒素基因（）确定其存在。
检出率为 62.57%（1379/2204），其中 MRSA 占 14.79%（204/1379），明显高于 2009-2011 年（2.58%，44/1075）的研究结果。与以往研究相比， 对头孢菌素和夫西地酸的敏感性呈不同程度下降，而对氯霉素、环丙沙星、克林霉素、红霉素、庆大霉素、青霉素和四环素的敏感性显著增加。对莫匹罗星、复方磺胺甲噁唑（TRISUL）和利福平的敏感性仍保持在较高水平（分别为 97.90%、99.35%和 96.66%）。MRSA 和甲氧西林敏感金黄色葡萄球菌（MSSA）的主要多重耐药模式分别为红霉素-克林霉素-四环素（55.84%；43/77）和红霉素-克林霉素-氯霉素（27.85%，44/158）。检测到 12 株高水平耐莫匹罗星的菌株，且地理位置分布和季节性变化存在显著差异。MRSA 的主要类型为 ST121（46.08%，94/204），其次为 ST59（19.61%，40/204）。SCC V（65.69%，134/204）和 SCC IV（31.86%，65/204）为主要流行类型。ST121-V、ST59-IV 和 ST22-V 是全国最流行的克隆。从 2009-2011 年的 9.09%（4/44）到 2019-2021 年的 22.55%（46/204）， 的检出率显著增加（P<0.05）。
过去十年中，儿童皮肤软组织感染中 的抗生素敏感性和分子特征发生了显著变化。为了规范医疗，提供及时合理的临床治疗，并有效管理感染控制，中国儿科皮肤软组织感染指南亟待制定。
