【摘要】：目的探究唐山地區(qū)兒童CA-MRSA菌株的臨床感染特點、分子分型及耐藥性特征。方法收集2013年8月-2016年12月在兒童中分離到的金黃色葡萄球菌菌株,采用BD Phoenix?-100全自動細菌鑒定/藥敏系統(tǒng)完成鑒定及藥敏分析,頭孢西丁紙片擴散法篩選出MRSA,調(diào)查病歷確定為社區(qū)獲得性耐甲氧西林金黃色葡萄球菌(CA-MRSA),普通PCR技術(shù)和瓊脂糖凝膠電泳技術(shù)檢測mec A基因,以確證是MRSA。并采用多重PCR技術(shù)和瓊脂糖凝膠電泳技術(shù),進行葡萄球菌染色體mec基因盒(SCCmec)分型。再采用普通PCR技術(shù)、瓊脂糖凝膠電泳技術(shù)以及DNA測序技術(shù)相結(jié)合,對菌株進行葡萄球菌A蛋白基因(spa)分型和多位點序列分型(MLST)以及殺白細胞毒素基因(pvl)攜帶情況進行研究。結(jié)果1病例符合標(biāo)準(zhǔn)的菌株共檢出102株CA-MRSA,標(biāo)本類型以痰液和膿性分泌物為主,在102例感染CA-MRSA的患兒中,男64例(62.7%),女38例(37.3%),年齡為0-14歲,其中0-28天24例(23.5%),28天-6月45例(44.1%),6月-1歲15例(14.7%),1歲-3歲14例(13.7%),3歲-14歲4例(3.9%)。2在CAMRSA患兒中,最常見的感染為肺炎55例,其次為皮膚軟組織感染37例,血流感染8例。3 102例菌株對于利奈唑胺、替考拉寧、萬古霉素全部為100%敏感,對于β-內(nèi)酰胺類抗生素100%耐藥,然而對于紅霉素、克林霉素、甲氧芐胺嘧啶、四環(huán)素、妥布霉素的耐藥率較高,分別為93.1%、89.2%、44.1%、26.5%、13.7%,其他的抗生素具有不同的耐藥表現(xiàn)。4 SCCmec基因分型共有五種類型,其中SCCmec IV占56.9%(58/102),SCCmec V占18.6%(19/102),SCCmec III占11.8%(12/102),SCCmec II占3.9%(4/102),SCCmec I占1.0%(1/102)。pvl陽性攜帶率為29.4%(30/102)。spa分型17種,以t437為主,占48.0%,其他型別還有t324、t441、t021、t309、t318、t668、t968、t1751、t3523、t3527、t3424、t2592、t127、t037、t030、t311,未分型菌株有3株。MLST分型14種,以ST59為主,占48.0%(49/102),其次是ST910(10)和ST88(13),存在的其他型別還有ST5、ST398、ST30、ST1777、ST82、ST45、ST338、ST1、ST72、ST239和ST22。5在102株CA-MRSA菌株中,其流行的分子克隆是以MRSA-ST59-SCCmec IVa-t437為主,共30株,所占比例為29.4%,其次的分子克隆為MRSA-ST59-SCCmec Vt437,共10株,所占比例為9.8%。流行分子克隆MRSA-ST59-SCCmec IVa-t437菌株,對于β-內(nèi)酰胺類抗生素100%耐藥,對利奈唑胺、替考拉寧、萬古霉素100%敏感,對于紅霉素、克林霉素、甲氧芐胺嘧啶和四環(huán)素的耐藥率較高,分別為90.0%、83.3%、63.3%和36.7%,其他的抗生素具有不同的耐藥表現(xiàn)。結(jié)論1兒童CA-MRSA引起的感染主要是肺炎和皮膚軟組織感染,感染的患兒以嬰幼兒為主。2兒童CA-MRSA感染的經(jīng)驗性治療慎用克林霉素和紅霉素,可以應(yīng)用利奈唑胺、替考拉寧、萬古霉素,最好個性化治療。3兒童CA-MRSA感染的流行分子克隆以MRSA-ST59-SCCmec IVa-t437為主,與中國大陸其他地區(qū)相同。4流行分子克隆MRSA-ST59-SCCmec IVa-t437菌株,對于β-內(nèi)酰胺類抗生素耐藥,對利奈唑胺、替考拉寧、萬古霉素敏感,對于紅霉素、克林霉素、甲氧芐胺嘧啶和四環(huán)素的耐藥率較高。
[Abstract]:Objective to investigate the clinical infection characteristics, molecular typing and drug resistance of CA-MRSA strains in children in Tangshan area. Methods Staphylococcus aureus strains isolated from children from August 2013 to December 2016 were collected and identified by BD Phoenix?-100 automatic bacterial identification / drug sensitivity system. Cefxitin disk diffusion method was used to screen out the history of MRSA, investigation confirmed as community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA), common PCR and agarose gel electrophoresis were used to detect mec A gene, which was confirmed as MRSA.. Multiplex PCR and agarose gel electrophoresis were used for (SCCmec) typing of staphylococcus chromosome mec cassette. The common PCR technique, agarose gel electrophoresis and DNA sequencing techniques were used to study the carrying of staphylococcal A protein gene (spa) typing, multilocus sequence typing (MLST) and leukocytotoxin gene (pvl). Results (1) sputum and purulent secretions were the main types of CA-MRSA, samples from 102 patients who met the criteria. 64 (62.7%) males and 38 (37.3%) females were infected with CA-MRSA, aged 0-14 years. There were 24 cases (23.5%) with 0-28 days and 45 cases (44.1%) from 28 days to June, 15 cases (14.7%) from June to June, 14 cases (13.7%) from 1 year old to 3 years old, 4 cases (3.9%) from 3 to 14 years old. Among the children with CAMRSA, the most common infection was pneumonia in 55 cases, followed by skin and soft tissue infection in 37 cases. Blood flow infection 8 cases 3.102 strains were 100% sensitive to linazolamine, teicoplanin and vancomycin, and 100% resistant to 尾 -lactam antibiotics. However, they were resistant to erythromycin, clindamycin, methoxybenzylamine, tetracycline, erythromycin, clindamycin, methoxybenzylamine, tetracycline. 濡ュ竷闇夌礌鐨勮，

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