Clonal and drug-resistance dynamics of Methicillin-resistant Staphylococcus aureus in pediatric populations in China
Clonal and drug-resistance dynamics of Methicillin-resistant Staphylococcus aureus in pediatric populations in China
复制标题
中国儿童人群耐甲氧西林金黄色葡萄球菌克隆及耐药动态
DOI：
10.1002/ped4.12129
复制
发表时间：
2019
影响因子：
2.2
通讯作者：
Wei Zhou
中科院分区：
文献类型：
--
作者：
Xin Yang;Yingchao Liu;Lijuan Wang;Suyun Qian;Kaihu Yao;Fang Dong;Wenqi Song;Hong Xu;Jinghui Zhen;Wei Zhou
耐甲氧西林金黄色葡萄球菌(MRSA)的区域克隆性替换很常见。目的了解2010~2017年间中国儿童耐甲氧西林金黄色葡萄球菌(MRSA)的克隆性及耐药动态。方法从北京儿童医院2010~2013年和2016~2017年间分离出MRSA。结果共收集到211株耐甲氧西林金黄色葡萄球菌(MRSA)，其中104株为社区相关性耐甲氧西林金黄色葡萄球菌(CA-MRSA)。ST59-SCCmecIV在CA-MRSA(65.4%)和医疗保健相关-MRSA(HA-MRSA)(46.7%)中均是最常见的类型。ST239-SCCmecIII占所有HA-MRSA的21.5%，2016年没有检测到，2017年只检测到3株。CA-MRSA的pv1基因携带率显著高于HA-MRSA(42.3%vs.29.0%，P=0.0456)。在CA-MRSA中，2010-2013年和2016-2017年期间，除氯霉素外的所有测试抗生素的耐药率保持稳定。HA-MRSA对苯唑西林、庆大霉素、四环素、环丙沙星和利福平的耐药率总体呈下降趋势，而对氯霉素的耐药率呈上升趋势，这与ST59-SCCmecIV和ST239-SCCmecIII分离株的耐药谱差异一致。在研究期间，所有MRSA和ST59-SCCmecIV分离株均发现万古霉素最低抑菌浓度(MIC)蠕变。说明ST59-SCCmecIV已蔓延到医院，取代了传统的ST239-SCCmecIII克隆，并伴随着耐药性的变化。此外，万古霉素MIC蠕变提示应认真考虑抗生素的合理使用。
ImportanceRegional clonal replacements of methicillin-resistantStaphylococcus aureus(MRSA) are common. It is necessary to understand the clonal and drug resistance changes in specific areas.ObjectiveTo evaluate the clonal and drug resistance dynamics of MRSA in Chinese children from 2010 to 2017.MethodsMRSA was isolated from patients in Beijing Children’s Hospital from 2010 to 2013 and from 2016 to 2017. The molecular characteristics and antibiotic resistance were determined.ResultsIn total, 211 MRSA isolates were collected, and 104 isolates were classified as community-associated MRSA (CA-MRSA). ST59-SCCmecIV was the most prevalent type in both CA-MRSA (65.4%) and healthcare-associated-MRSA (HA-MRSA) (46.7%). ST239-SCCmecIII accounted for 21.5% of all HA-MRSA, which were not detected in 2016, and only three isolates were detected in 2017. Thepvlgene carrying rate of CA-MRSA was significantly higher than that of HA-MRSA (42.3% vs. 29.0%,P= 0.0456). Among CA-MRSA, resistance rate to all tested antibiotics excluding chloramphenicol remained stable over the periods of 2010–2013 and 2016–2017. HA-MRSA displayed an overall trend of decreased resistance to oxacillin, gentamicin, tetracycline, ciprofloxacin, and rifampin, and increased resistance to chloramphenicol, consistent with the difference of antibiotic resistance patterns between ST59-SCCmecIV and ST239-SCCmecIII isolates. Vancomycin minimal inhibitory concentration (MIC) creep was found in the study period in all MRSA and ST59-SCCmecIV isolates.InterpretationST59-SCCmecIV has spread to hospitals and replaced the traditional ST239-SCCmecIII clone, accompanied by changes in drug resistance. Furthermore, vancomycin MIC creep indicated that the rational use of antibiotics should be seriously considered.