Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Department of Pediatrics, Chosun University hospital, Gwangju, Republic of Korea.
BMC Infect Dis. 2024 Feb 24;24(1):259. doi: 10.1186/s12879-023-08914-5.
While there is a high burden of methicillin-resistant Staphylococcus aureus (MRSA) infections among pediatric patients, studies on the molecular epidemiology of MRSA infections in Korean children since the 2010s are lacking. This study aimed to investigate the molecular genotypes and clinical characteristics of MRSA isolates from children with MRSA bacteremia at Asan Medical Center Children's Hospital from 2016 to 2021.
Clinical data were retrospectively reviewed, and the molecular types of MRSA were determined using multilocus sequence typing (MLST) and Staphylococcal cassette chromosome mec (SCCmec) typing.
The overall methicillin resistance rate of S. aureus bacteremia was 44.8% (77/172); 49.5% in the period 2016-2018 (period 1) and 37.3% in the period 2019-2021 (period 2) (P = 0.116). Community-acquired infections accounted for only 3.9% of cases. The predominant ST group was ST72 group (67.6%), followed by ST5 group (18.9%) and ST1 group (5.4%). The proportion of ST5 was significantly lower in period 2 compared to period 1 (P = 0.02). Compared to the ST5 and ST1 groups, the ST72 group exhibited lower overall antibiotic resistance and multidrug-resistant (MDR) rates (12.0% [6/50] in ST72 group vs. 100.0% [14/14] in ST5 group vs. 50.0% [2/4] in ST1 group; P < 0.001). In the multivariate analysis, the ST1 group was an independent risk factor for 30-day all-cause mortality (aOR, 44.12; 95% CI, 3.46-562.19).
The ST72-MRSA strain remained the most frequently isolated genotype in Korean children, while the ST1 group emerged as an independent risk factor for 30-day all-cause mortality in pediatric MRSA bacteremia. Ongoing efforts to uncover the evolving epidemiology of MRSA are essential for developing effective strategies for prevention and treatment.
耐甲氧西林金黄色葡萄球菌（MRSA）感染在儿科患者中负担沉重，但自 21 世纪 10 年代以来，针对韩国儿童中 MRSA 感染的分子流行病学研究尚缺乏。本研究旨在调查 2016 年至 2021 年期间，在 Asan 医疗中心儿童医院发生 MRSA 菌血症的儿童中，MRSA 分离株的分子基因型和临床特征。
回顾性分析临床资料，采用多位点序列分型（MLST）和葡萄球菌盒染色体 mec（SCCmec）分型确定 MRSA 的分子类型。
金黄色葡萄球菌菌血症的总体耐甲氧西林率为 44.8%（77/172）；2016-2018 年期间为 49.5%（时期 1），2019-2021 年期间为 37.3%（时期 2）（P=0.116）。社区获得性感染仅占 3.9%。主要 ST 群为 ST72 群（67.6%），其次是 ST5 群（18.9%）和 ST1 群（5.4%）。与时期 1 相比，时期 2 中 ST5 群的比例显著降低（P=0.02）。与 ST5 和 ST1 群相比，ST72 群的总体抗生素耐药率和多重耐药（MDR）率较低（ST72 群 12.0%[6/50]，ST5 群 100.0%[14/14]，ST1 群 50.0%[2/4]；P<0.001）。多变量分析显示，ST1 群是儿科 MRSA 菌血症 30 天全因死亡率的独立危险因素（调整后比值比，44.12；95%置信区间，3.46-562.19）。
ST72-MRSA 菌株仍然是韩国儿童中最常分离的基因型，而 ST1 群是儿科 MRSA 菌血症 30 天全因死亡率的独立危险因素。为制定有效的预防和治疗策略，需要不断努力揭示 MRSA 的不断变化的流行病学。
