儿童骨与关节感染耐甲氧西林金黄色葡萄球菌的临床和分子特征。
Clinical and molecular characteristics of methicillin-resistant Staphylococcus aureus in bone and joint infection among children.
机构信息
Department of Clinical Microbiology Laboratory, Children's Hospital of Fudan University, National Children's Medical Center, 399 Wanyuan Road, Shanghai, 201102, China.
Nosocomial Infection Control Department, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China.
出版信息
Ann Clin Microbiol Antimicrob. 2023 Nov 22;22(1):104. doi: 10.1186/s12941-023-00654-3.
OBJECTIVE
To investigate the characteristics of Methicillin-Resistant Staphylococcus aureus (MRSA) in bone and joint infection (BJI) among children.
METHODS
A total of 338 patients diagnosed with BJI from 2013 to 2022 in Children's Hospital of Fudan University were enrolled. Demographic information, microbiology culture results and laboratory findings, including white blood counts (WBC), C-reactive protein (CRP), procalcitonin (PCT), interleukin-6 (IL-6), and erythrocyte sedimentation rate (ESR) were collected and analyzed. MRSA was confirmed by antimicrobial susceptibility testing. Other MRSA-caused infections were randomly selected for comparison. Twenty-three virulence and antimicrobial resistance (AMR) genes were screened for MRSA strains. Multilocus sequence typing (MLST) and Staphylococcal protein A (spa) typing were performed using PCR amplification and sequencing.
RESULTS
Of the identified pathogens in BJI, MRSA accounted for 21.0% (47/224). Patients with BJI had high levels of initial CRP, white blood cell count (WBC) and IL-6. ST59 (43.9%) and t437 (37.6%) were the main MRSA subtypes isolated from the children. The major genotypes in BJI were ST59-t437 (29.8%) and ST22-t309 (14.9%), with high carriage of hemolysins including hla (94.4-100%), hlb (66.2-93.3%), and hld (100%). Notably, Panton-Valentine leukocidin (pvl) had a high prevalence (53.3%) in ST22-t309-MRSA. Other virulence genes including tst, seg and sei were more commonly detected in ST22-t309-MRSA (40.0-46.7%) than in ST59-t437-MRSA (4.2-9.9%). High-carriage AMR genes in MRSA included aph(3')/III (66.7-80%), ermB (57.5-73.3%) and ermC (66.7-78.9%). MRSA presented high-resistance to erythromycin (52.0-100%) and clindamycin (48.0-92.5%), different genotypes displayed variation in their susceptibilities to antibiotics.
CONCLUSIONS
The major MRSA genotype in BJI was ST59-t437, followed by ST22-t309, with a higher prevalence of the pvl gene. Continuous surveillance of pvl-positive ST22-t309-MRSA in pediatric BJI infections is thus required.
目的
探讨儿童骨髓炎和关节炎感染（BJI）中耐甲氧西林金黄色葡萄球菌（MRSA）的特征。
方法
纳入 2013 年至 2022 年在复旦大学附属儿科医院诊断为 BJI 的 338 例患者。收集人口统计学信息、微生物培养结果和实验室检查结果，包括白细胞计数（WBC）、C 反应蛋白（CRP）、降钙素原（PCT）、白细胞介素 6（IL-6）和红细胞沉降率（ESR）。通过抗菌药物敏感性试验确认 MRSA。随机选择其他由 MRSA 引起的感染进行比较。筛选了 23 种毒力和抗生素耐药（AMR）基因的 MRSA 株。采用 PCR 扩增和测序进行多位点序列分型（MLST）和葡萄球菌蛋白 A（spa）分型。
结果
在 BJI 中鉴定的病原体中，MRSA 占 21.0%（47/224）。BJI 患儿的初始 CRP、白细胞计数（WBC）和 IL-6 水平较高。ST59（43.9%）和 t437（37.6%）是从儿童中分离出的主要 MRSA 亚型。BJI 中的主要基因型为 ST59-t437（29.8%）和 ST22-t309（14.9%），携带多种溶血素，包括 hla（94.4-100%）、hlb（66.2-93.3%）和 hld（100%）。值得注意的是，ST22-t309-MRSA 中 Panton-Valentine 白细胞毒素（pvl）的流行率很高（53.3%）。其他毒力基因，如 tst、seg 和 sei 在 ST22-t309-MRSA 中更为常见（40.0-46.7%），而在 ST59-t437-MRSA 中则较少见（4.2-9.9%）。MRSA 中高携带 AMR 基因包括 aph（3'）/III（66.7-80%）、ermB（57.5-73.3%）和 ermC（66.7-78.9%）。MRSA 对红霉素（52.0-100%）和克林霉素（48.0-92.5%）的耐药率较高，不同基因型对抗生素的敏感性存在差异。
结论
BJI 中主要的 MRSA 基因型为 ST59-t437，其次是 ST22-t309，pvl 基因的流行率较高。因此，需要对儿科 BJI 感染中 pvl 阳性 ST22-t309-MRSA 进行持续监测。
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