NEONATAL NECROTIZING ENTEROCOLITIS ASSOCIATED WITH DELTA TOXIN-PRODUCING METHICILLIN-RESISTANT STAPHYLOCOCCUS-AUREUS
NEONATAL NECROTIZING ENTEROCOLITIS ASSOCIATED WITH DELTA TOXIN-PRODUCING METHICILLIN-RESISTANT STAPHYLOCOCCUS-AUREUS
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DOI：
10.1097/00006454-199002000-00005
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发表时间：
1990-02-01
影响因子：
3.6
通讯作者：
WONG, LC
中科院分区：
文献类型：
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作者：
OVERTURF, GD;SHERMAN, MP;WONG, LC
以前，产生δ毒素的凝固酶阴性葡萄球菌与新生儿坏死性小肠结肠炎有关。我们确定了三个早产儿（体重，845 . ±. 59 g）感染耐甲氧西林金黄色葡萄球菌（MRSA），临床表现相似，以脓疱性皮炎、菌血症和坏死性小肠结肠炎为特征，并伴有胃残留、腹胀、便血和积气。MRSA从所有三名婴儿的感染皮肤部位、血液或静脉导管中回收，从三名婴儿中的两名婴儿的粪便标本中回收。两名婴儿还从粪便中分离出表皮葡萄球菌。所有MRSA分离株具有相同的微生物学特征：具有相同分子量的四种质粒;肠毒素A和B的共同产生;以及相同的抗生素敏感性。在测试的MRSA的一个皮肤分离株、两个血液分离株和两个粪便分离株中，都具有特征性δ毒素溶血活性。通过Western印迹分析，针对δ毒素评估的这些分离株的所有培养物上清液均为阳性。两株S.通过标准化酶联免疫测定，从粪便中分离的表皮细胞对δ样毒素呈阴性。这些病例的聚集性、临床症状的相似性以及坏死性小肠结肠炎与S.表皮葡萄球菌，表明产生δ毒素的MRSA（或其他S。金黄色葡萄球菌分离株）也可能是新生儿坏死性小肠结肠炎某些病例的病原体。
Delta toxin-producing coagulase-negative staphylococci previously have been associated with necrotizing enterocolitis in neonates. We identified three preterm infants (body weight, 845 .+-. 59 g) infected with methicillin-resistant Staphylococcus aureus (MRSA) who had a similar clinical syndrome, characterized by pustular dermatitis, bacteremia and necrotizing enterocolitis accompanied by gastric residual, abdominal distention, hematochezia and pneumatosis intestinalis. MRSA was recovered from all three infants at infected skin sites, blood or venous catheters and from two of three infants in stool specimens. Two infants also had Staphylococcus epidermidis isolated from stool. All MRSA isolates had identical microbiologic profiles: four plasmids with identical molecular weights; coproduction of entertoxins A and B; and the same antibiotic susceptibilities. Of one skin isolate, two blood isolates and two stool isolates of MRSA that were tested, all had characteristic delta toxin hemolytic activity. All culture supernatnants of these isolates evaluated for delta toxin were positive by Western blot analysis. The two strains of S. epidermidis isolated from stool were negative for delta-like toxin by a standardize enzyme-linked immunoassay. The clustering of these cases, the similarity of the clinical syndrome, and the prior association of necrotizing enterocolitis with delta-like toxins produced by S. epidermidis, suggest that delta toxin-producing MRSA (or other S. aureus isolates) also may be etiologic agents in some cases of necrotizing enterocolitis in newborns.