CAJ | 학술논문

目的探讨儿童耐甲氧西林金黄色葡萄球菌(MRSA)感染临床及分子学特征.方法采用队列研究方法,对复旦大学附属儿科医院2009年3月至2011年11月因MRSA感染住院患儿的临床特征进行分析；采用聚合酶链式反应(PCR)检测mecA、杀白细胞素(PVL)基因在MRSA菌株中的分布情况；多重PCR法检测MRSA SCCmec分型.结果 (1)37株MRSA中,21株来源于医院(HA-MRSA),16株来源于社区(CA-MRSA).MRSA感染以呼吸道感染最常见,分布以重症监护病房最多.(2)CA-MRSA感染可引起皮肤软组织感染、化脓性扁桃体炎等,严重者亦可引起肺炎、败血症等,而HA-MRSA感染更具侵袭性,其多引起肺炎、败血症,亦可引起脑膜炎.MRSA感染所致发热患儿中,与CA-MRSA感染者热程(4 d)相比,HA-MRSA感染者表现出更长的热程(10.5 d),HA-MRSA感染患儿C反应蛋白(63.00 mg/L)较CA-MRSA(9.50 mg/L)高,差异有统计学意义(t=2.5670,P＜0.05).白细胞计数、降钙素原差异无统计学意义.(3)37株MRSA中,mecA基因的检出率为100％.SCCmec分型以SCCmecⅢ型最多见,共17株,其次是SCCmecⅣ型8株,SCCmecⅡ型1株,未分型11株,未发现SCCmec Ⅰ、V型.其中,在21株HA-MRSA中,SCCmecⅢ型最多见,为15株,SCCmecⅣ型1株,未分型者5株；在16株CA-MRSA中,SCCmecⅣ型最多见,为7株,Ⅲ型2株,Ⅱ型1株,未分型者6株.(4)37株MRSA中,PVL基因阳性28株,在HA-MRSA中为17株(81％),在CA-MRSA中为11株(69％),两者检出率差异无统计学意义(x2=0.735,P＞0.05).结论 HA-MRSA与CA-MRSA相比,其感染更具侵袭性,所致炎性指标(C反应蛋白)更高；CA-MRSA主要为SCCmecⅣ型,而HA-MRSA主要为SCCmecⅢ型；PVL毒力基因检出率高.
목적 탐토인동내갑양서림금황색포도구균(MRSA)감염림상급분자학특정.방법 채용대렬연구방법,대복단대학부속인과의원2009년3월지2011년11월인MRSA감염주원환인적림상특정진행분석；채용취합매련식반응(PCR)검측mecA、살백세포소(PVL)기인재MRSA균주중적분포정황；다중PCR법검측MRSA SCCmec분형.결과 (1)37주MRSA중,21주래원우의원(HA-MRSA),16주래원우사구(CA-MRSA).MRSA감염이호흡도감염최상견,분포이중증감호병방최다.(2)CA-MRSA감염가인기피부연조직감염、화농성편도체염등,엄중자역가인기폐염、패혈증등,이HA-MRSA감염경구침습성,기다인기폐염、패혈증,역가인기뇌막염.MRSA감염소치발열환인중,여CA-MRSA감염자열정(4 d)상비,HA-MRSA감염자표현출경장적열정(10.5 d),HA-MRSA감염환인C반응단백(63.00 mg/L)교CA-MRSA(9.50 mg/L)고,차이유통계학의의(t=2.5670,P＜0.05).백세포계수、강개소원차이무통계학의의.(3)37주MRSA중,mecA기인적검출솔위100％.SCCmec분형이SCCmecⅢ형최다견,공17주,기차시SCCmecⅣ형8주,SCCmecⅡ형1주,미분형11주,미발현SCCmec Ⅰ、V형.기중,재21주HA-MRSA중,SCCmecⅢ형최다견,위15주,SCCmecⅣ형1주,미분형자5주；재16주CA-MRSA중,SCCmecⅣ형최다견,위7주,Ⅲ형2주,Ⅱ형1주,미분형자6주.(4)37주MRSA중,PVL기인양성28주,재HA-MRSA중위17주(81％),재CA-MRSA중위11주(69％),량자검출솔차이무통계학의의(x2=0.735,P＞0.05).결론 HA-MRSA여CA-MRSA상비,기감염경구침습성,소치염성지표(C반응단백)경고；CA-MRSA주요위SCCmecⅣ형,이HA-MRSA주요위SCCmecⅢ형；PVL독력기인검출솔고.
Objective To study the clinical and molecular characteristics of methicillin-resistant Staphylococcus aureus (MRSA) infection in children.Method A total of 37 MRSA strains were isolated from hospitalized patients in Children's Hospital of Fudan University from March 2009 to November 2011.The clinical characteristics were investigated by a cohort study.Furthermore,the mecA,Panton-Valentine leucocidin (PVL) genes were detected by polymerase chain reaction (PCR),and the genotypes of SCCmec were determined by multiplex PCR.Result (1) Among the 37 MRSA isolates,infections with 21 were acquired from hospital (HA-MRSA),and 16 isolates were acquired from community (CA-MRSA).(2) In the study,MRSA frequently caused respiratory tract iffection,and most of the strains were isolated from intensive care unit (ICU).(3) CA-MRSA was most frequently associated with skin and soft tissue infections (SSTI),suppurative tonsillitis,even pneumonia and septicemia.HA-MRSA infection was more aggressive,most frequently associated with pneumonia,septicemia,and central nervous system (CNS) infections,such as meningitis.In children with fever caused by HA-MRSA or CA-MRSA infection,HA-MRSA showed a longer duration of fever,for 10.5 days.C-reactive protein (CRP) level caused by HA-MRSA (63.00 mg/L) was higher than CA-MRSA(9.50 mg/L),and there were statistically significant differences between the groups(t =2.5670,P ＜ 0.05).However,there were no statistically significant differences between the groups in white blood cell count (WBC) or procalcitonin (PCT) level.(4) Among 37 MRSA isolates,the whole isolates were mecA gene positive (100％).SCCmec genotyping results showed that the most frequent SCCmec types were type Ⅲ,17 isolates,the others including type Ⅳ 8 isolates,type Ⅱ 1 isolates,nontypable 11 isolates,type Ⅰ and type V were not found in this group.Therein,among 21 HA-MRSA isolates,SCCmec Ⅲ was the most common,15 isolates,type Ⅳ 1 isolates,nontypable 5 isolates; among 16 CA-MRSA isolates,SCCmec type Ⅳ was the most common,7 isolates,type Ⅲ 2 isolates,type Ⅱ 1 isolate,nontypable 6 isolates.(5) Among the 37 MRSA isolates,28 were PVL gene positive; and among 21 HA-MRSA isolates,17 were PVL gene positive; Among 16 CA-MRSA isolates,ll were PVL gene positive;There were no statistically significant differences between the groups (x2 =0.735,P ＞ 0.05).Conclusion Compared with CA-MRSA,HA-MRSA infection was more aggressive,and induced higher C reactive protein;the dominant epidemic strains of CA-MRSA was SCCmec type Ⅳ,and HA-MRSA was SCCmec type Ⅲ ; the positive rate of PVL gene was high.