金黄色葡萄球菌与湿疹关系的探讨

我们就湿疹患者金葡菌带菌率、金葡菌甘露醇发酵试验和噬菌体谱型以及金葡菌与表皮细胞的粘附性等方面进行了研究.结果表明:1.金葡菌是湿疹皮疹中的主要细菌,2.大多数湿疹金葡菌能分解甘露醇,在分型方面,寻常性湿疹株可分率较低,细菌性湿疹株和化脓性感染株的可分率较高,在噬菌体组分布中,湿疹株和对照株之间差异无显著性(P>0.05),3.湿疹皮疹的表皮细胞对金葡菌的粘附力大于正常皮肤.最后就金葡菌与湿疹的关系进行了讨论.     

新生儿皮肤金黄色葡萄球菌感染的耐药性检测

目的：检测母婴同室新生儿皮肤金黄色葡萄球菌（简称金葡菌）感染的耐药状况。方法：对2009年1月至2010年12月206例皮肤感染的新生儿皮损分泌物进行细菌培养,应用琼脂稀释法检坝419种抗生素对金葡菌的最小抑菌浓度。结果：培养出金葡菌45株,分离率29．22％;其耐药率前3位依次为青霉素、氨苄西林和红霉素。结论：新生儿金葡菌的检出率与国内其他研究相似,治疗首选半合成青霉素或头孢类抗生素。     

金黄色葡萄球菌感染与特应性皮炎

特应性皮炎（AD）患者存在免疫功能紊乱，而感染是诱发免疫功能紊乱的重要因素之一，其中以金黄色葡萄球菌（金葡菌）感染倍受关注，研究发现，AD患者皮肤金葡菌定植率高，与病变活动一致。金葡菌可通过超抗原或非超抗原途径，激发机体的炎症反应，抗金葡菌治疗对AD病情控制有一定的作用。     

葡萄球菌性烫伤样皮肤综合征的致病金黄色葡萄球菌剥脱毒素基因型及耐药研究

目的 探讨葡萄球菌性烫伤样皮肤综合征（SSSS）致病的金黄色葡萄球菌（简称金葡菌）分泌表皮剥脱毒素（ET）的主要类型及耐药情况。方法 108株金葡菌分离自SSSS（36例）、脓疱疮（36例）及皮肤脓肿（36例）。用多重PCR法测定致病金葡菌菌株产ETA、ETB、ETD基因型，Kirby-Bauer纸片法检测其对20种抗生素的敏感性。结果 36株来源于SSSS的金葡菌 100％ （36/36）为产ET菌株，其中单产ETA 2株（6％），ETB 7株（19％），兼产ETA和ETB 27株（75％）。来源于脓疱疮的36株金葡菌78％ （28/36）为产ET菌株，单产ETA 5株（14％），兼产ETA和ETB 23株（64％），未发现单产ETB金葡菌。而分离自皮肤脓肿的36株金葡菌仅2.8%（1/36）产ET，为兼产ETA和ETB菌株。108株金葡菌均未检测到ETD。金葡菌产ET的型别分布在三组疾病间差异有统计学意义（χ2 = 89.4，P ＜ 0.01），且分离自SSSS的金葡菌株产ET的比例明显高于脓疱疮组（χ2 = 9.0，P < 0.01）和脓肿组（χ2 = 68.1，P < 0.01）。三组病例的致病金葡菌对青霉素、氨苄西林、大环内酯类及克林霉素高度耐药，但对头孢类抗生素均敏感。脓肿组发现2例耐甲氧西林金葡菌株（MRSA）。结论 SSSS及脓疱疮患儿的致病金葡菌主要为产ET菌株，并以兼产ETA和ETB菌株为主。     

非特应性的湿疹皮炎患者皮肤菌群的测定与分析

目的：探讨非特应性的湿疹皮炎患者携带细菌尤其是金黄色葡萄球菌（金葡菌）的携带情况。方法：选取正常人30名及门诊非特应性的湿疹皮炎患者186例，以棉签法分别在正常人及皮损部位反复擦拭后进行细菌培养及鉴定。结果：正常人未检出金葡菌；湿疹继发感染患者皮损金葡菌及细菌总检出率均为92.9%；非特应性的湿疹皮炎患者金葡菌检出率和细菌总检出率分别为30.1%和67.7%；临床无感染的湿疹皮炎患者金葡菌检出率和细菌总检出率分别为25.0%和65.7%，后两者金葡菌及细菌总检出率均显著低于湿疹继发感染患者，而金葡菌检出率显著高于正常人。结论：金葡菌与一部分非特应性的湿疹皮炎可能有一定的关系。     

64例孢子丝菌病临床分析

分析2006年11月至2010年4月我院门诊疑诊抱子丝菌感染病例,利用真菌培养检查和/或皮肤组织病理检查对64例疑诊孢子丝菌病进行统计分析.64例真菌培养阳性(可见孢子丝菌生长),10例皮肤组织病理切片、PAS染色找到真菌孢子或星状体.发病部位主要在裸露部位58例(90.63%),如手部、前臂、面部和小腿等.有明确外伤史11例,皮损类型主要为固定型、皮肤淋巴管型、化脓性肉芽肿卫星型.各种因素(建筑、环境污染、自然灾害等)和腐生菌大量繁殖生长是导致孢子丝菌感染的重要原因,外伤和昆虫叮咬是重要致病条件.     

特应性皮炎皮损金黄色葡萄球菌检出情况的研究

目的 :　探讨特应性皮炎 (AD)皮损微生物定植情况 ,为临床合理选用抗菌药物有效控制该病提供依据。方法 :　无菌生理盐水浸湿的棉拭子于 4 3例AD患者皮损处取标本 ,同时对 39例患者非皮损处及 10例健康人取标本作对照 ,进行细菌培养及菌落计数 ,金葡菌予常规药敏试验。结果 :　AD患者皮损细菌阳性率为 74 .4 2 % ,金葡菌为主要的致病菌 ,占 6 5 .6 3% ;非皮损处也可分离出细菌 ,但金葡菌阳性率及密度均明显低于皮损处 (P <0 .0 0 1)。结论 :　微生物感染因素 ,尤其金葡菌感染或定植 ,在AD的发病中起着重要的作用     

湿疹和特应性皮炎皮损处细菌定植情况及药物联合治疗的分析

目的 探讨湿疹和特应性皮炎(AD)皮损处金黄色葡萄球菌(金葡菌)及其他细菌的定植情况,评价抗菌药物与糖皮质激素联合用药的疗效。方法 采用多中心、随机、双盲试验,在筛选日及治疗后第7、14和28天对皮损评分,并在皮损和非皮损处分离细菌。试验组外用抗菌药物和糖皮质激素,对照组外用基质和糖皮质激素。结果 共入选患者327例,湿疹208例,AD119例。湿疹皮损处细菌的阳性率为70.19%,金葡菌占47.26%;非皮损部位细菌阳性率为32.69%,金葡菌占27.94%。AD皮损处细菌阳性率为74.79%,金葡菌占79.78%;非皮损部位细菌阳性率为34.45%,金葡菌占80.49%。湿疹和AD皮损部位金葡菌的定植量均高于非皮损部位(P<0.01,P<0.05),细菌的定植量与皮损的严重程度呈正相关。两组患者治疗后总体疗效无明显差异(P>0.05),但湿疹临床症状评分指数>8分者及AD评分指数>7分者,在治疗的第7天,试验组与对照组的症状评分指数改善率存在显著差异(P<0.05),在治疗的第14天和第28天,两组差异均无显著性(P>0.05)。结论 湿疹和AD患者皮损部位细菌的检出率和金葡菌的带菌率均明显增高,说明金葡菌与湿疹皮炎的关系密切,早期联用抗菌药物可提高疗效。     

红色毛癣菌菌落表型和基因型的分型研究

目的:确定红色毛癣菌菌落表型和基因型的相关性以及与感染部位的关系。方法:收集红色毛癣菌临床分离株138株,采用传统培养方法对红色毛癣菌进行表型分型,利用红色毛癣菌特异性引物扩增TRS-1区重复序列进行种内基因分型,并分析检测结果与感染部位的相关性。结果:138株红色毛癣菌共分离出3种菌落表型:绒毛型、沟纹型和粉末型;分离出5型基因型,其中Type1 64株,Type2 18株,Type3 19株,Type4 12株,Type5 25株。红色毛癣菌的表型和基因型与感染部位均无相关性(均P0.05),红色毛癣菌的菌落表型与基因型有一定的相关性(P0.05)。结论:红色毛癣菌基因型与菌株来源有关而与感染部位无关,可为判断复发和再感染提供依据。     

特应性皮炎患者皮损和非皮损处细菌定植分析

采集127例特应性皮炎(AD)患者皮损与非皮损处和健康人正常皮肤处的标本进行细菌培养,观察病原菌分布以及金黄色葡萄球菌(以下简称金葡菌)的检出率,采用湿疹面积与严重度指数(EASI)评价病情严重程度.AD皮损处、非皮损处和健康人对照组细菌阳性率分别为77.2％、20.5％和3.4％,差异具有统计学意义(P ＜0.05);AD皮损处和非皮损处金葡菌构成比分别为61.4％和11.0％,差异有统计学意义(P＜0.05),健康人对照组只分离到1株金葡菌.EASI评分和菌落密度在红斑、渗出、糜烂、皲裂和水肿等部位比较差异具有统计学意义(P＜0.05),经Spearman相关分析显示EASI评分和菌落密度呈正相关(r=0.529,P＜0.05).细菌定植尤其是金葡菌定植与AD的发生发展密切相关,菌落密度与AD的病情进展具有显著相关性.     

84株感染相关皮肤病MRSA SCCmec分型及PVL毒素检测

【摘要】 目的 探讨感染相关皮肤病耐甲氧西林金黄色葡萄球菌（MRSA）的SCCmec基因型别及PVL毒素携带情况。 方法 分离于感染相关皮肤病MRSA菌株及其相关信息,对所收集到的菌株利用PCR方法进行mecA鉴定,mecA阳性者确定为实验对象,再通过多重PCR的方法进行SCCmec基因分型及PVL毒素的测定。 结果 共收集95株MRSA,经鉴定mecA阳性者为84株,其中有5株携带PVL毒力基因。有69株为SCCmecⅢ型,占86.3%（69/84）,有3株为SCCmecⅠ型,占3.6%（3/84）,有8株为SCCmecⅣ型,占9.52%（8/84）,其余4株为不可分型,占4.8%（4/84）。未发现SCCmecⅡ、Ⅴ两型。 结论 感染相关皮肤病MRSA以HA-MRSA为主,SCCmec分型大部分为Ⅲ型,CA-MRSA及HA-MRSA均可携带PVL毒素。     

浅部与深部感染来源白念珠菌氟康唑耐药株药物敏感性及耐药基因突变比较

【摘要】 目的 比较浅部、深部感染来源的氟康唑耐药白念珠菌体外对8种抗真菌药物的敏感性及耐药基因突变。方法 26株深部感染来源白念珠菌耐药株、33株浅部感染来源白念珠菌耐药株,参照CLSI酵母菌检测方案M27-A4测定上述菌株对氟康唑、伏立康唑、伊曲康唑、泊沙康唑、两性霉素B、氟胞嘧啶、特比萘芬、米卡芬净8种药物单独或联合的体外敏感性。提取所有耐药菌株DNA,通过PCR检测ERG3、ERG11、FUR1 3种耐药基因的突变情况。满足正态分布和方差齐性检验的定量资料两组间比较采用独立样本t检验,不满足者组间比较采用Mann-Whitney U检验,定性资料组间比较采用卡方检验。结果 氟康唑、伊曲康唑、伏立康唑、泊沙康唑、氟胞嘧啶的最小抑菌浓度（MIC）在浅部感染组和深部感染组间差异均有统计学意义（均P＜0.05）,而两性霉素B、米卡芬净的MIC两组间差异无统计学意义（均P > 0.05）。96.6%的菌株特比萘芬MIC值＞64 μg/ml,无法进行组间对比。15株白念珠菌（7株深部感染来源、8株浅部感染来源）特比萘芬 + 唑类（氟康唑、伏立康唑、伊曲康唑、泊沙康唑）联合药敏试验均显示为协同效应,部分抑菌浓度（FIC）指数0.033～0.187;氟胞嘧啶 + 唑类、氟胞嘧啶 + 两性霉素B、两性霉素B + 氟康唑组合均无明显协同作用,FIC指数0.56～1.125。浅部感染来源白念珠菌ERG3基因突变包括错义突变V351A（33株,100%）,深部感染来源白念珠菌包括错义突变V351A（13株,50%）、A353T（4株,15%）;浅部感染来源白念珠菌ERG11基因突变包括错义突变I437V（32株,97%）、Y132H（23株,70%）、T123I（16株,48%）、K128T（6株,18%）、D116E（5株,15%）、A114S（4株,12%）、E266D（2株,6%）、G448E（2株,6%）、G465S（2株,6%）,深部感染来源白念珠菌包括I437V（23株,88%）、E266D（13株,50%）、E260G（5株,19%）、V488I（4株,15%）;浅部感染来源白念珠菌 FUR1基因突变包括错义突变R101C（11株,33%）,深部感染来源白念珠菌未检出错义突变。结论 浅部与深部感染来源白念珠菌氟康唑耐药株对药物的敏感性及基因突变位点均有所差别。     

Staphylococcus aureus in dermatology outpatients with special emphasis on community-associated methicillin-resistant strains

Methicillin-resistant Staphylococcus aureus (MRSA) emerged as a community-associated pathogen (CA-MRSA) in the past 6 years. This prospective study investigated dermatology outpatients with inflammatory skin diseases, leg ulcers, and skin infections for Panton-Valentine leukocidin (PVL)-positive S. aureus, often associated with deep skin infection. In case of PVL positivity, molecular typing and PCR demonstration of resistance genes were performed. Out of 248 patients, 130 carried S. aureus, 24 being lukS-PV lukF-PV positive. Eighteen were MRSA, 11 of them belonging to the multilocus sequence typing clonal complex (CC)5, 1 to CC45, and 2/18 to CC8. Out of 18 patients, 4 were CA-MRSA containing lukS-PV lukF-PV as an important trait of CA-MRSA. Out of four CA-MRSA isolates, two were of type ST080 containing far-1 coding for fusidic acid (FUS) resistance and two were FUS sensitive (ST152 and ST001). The FUS-sensitive CA-MRSA, which corresponded to the CA-MRSA of ST001 from the United States, was detected in Germany for the first time, indicating that dermatologists are first in line to detect CA-MRSA. In contrast to CA-MRSA from other continents, far-1-coded FUS resistance represents a typical marker for the widespread CA-MRSA ST080 in Europe, especially in Germany. The significant risk factor for the acquisition of CA-MRSA was visits to foreign countries and/or professional or private contacts with foreigners.     

汶川地震致头皮伤口感染细菌谱及耐药性分析

目的探讨地震灾害引起的开放性头皮损伤伤121感染的病原菌分布,耐药性特点及抗生素治疗措施。方法回顾分析5·12汶川地震后,四川大学华西医院神经外科收治的38例开放性颅伤患者头皮伤口感染的病原学资料。结果全组38例开放性头皮伤口感染的病原菌菌株51株,革兰阳性菌35株（68．63％）,分别是金黄色葡萄球菌21株（41．18％）,表皮葡萄球菌14株（27．45％）;革兰阴性菌16株（31．37％）,分别是阴沟肠杆菌8株（15．69％）,肺炎克雷伯杆菌4株（7．84％）,绿脓杆菌2株（3．92％）,深红沙雷氏菌2株（3．92％）。这些菌株对临床常用抗生素都有不同程度的耐药。经彻底清创及应用敏感抗生素,能有效控制感染。结论地震引起的开放性头皮伤口感染的病原菌,多以革兰阳性的金黄色葡萄球菌感染为主。早期彻底清创,营养支持,应用敏感抗生素能提高治疗效果。     

The Incidence of Isolation of Methicillin-resistant Staphylococcus aureus (MRSA) Strains from Skin Infections during the Past Three Years (1989–1991)

We did a statistical study of 294 strains of Staphylococcus aureus (S. aureus) isolated from skin infections during the period from January of 1989 to December of 1991 in the Department of Dermatology, Kansai Medical University Hospital. We especially examined methicillin-resistant S. aureus (MRSA) from the point of view of incidence, variety of skin infections with MRSA, coagulase type, phase type, and resistance against antimicrobial agents. The frequency of isolation of MRSA has been increasing. In 1991, the proportion of MRSA isolates among all S. aureus strains isolated from skin infections was 41.5%. MRSA was isolated most often from infectious decubitus. Coagulase type II and phage group NT (not typable) MRSA were most frequently isolated. The resistance of MRSA to OFLX and IMP/CS had remarkably increased. Notably, the resistance to MINO was low before 1991.     

Skin infections with MRSA. Epidemiology and clinical features

Staphylococcus aureus is the most prevalent pathogen in dermatology causing a broad array of pyogenic, community-acquired (CA) and health care-associated (HA), acute and chronic, superficial and deep skin infections which can progress to life-threatening systemic infections. The pathogen causes also toxin-mediated diseases with cutaneous symptoms. Methicillin-resistant S. aureus (MRSA) strains are not sensitive to the beta-lactam antibiotics available in Germany. Even though they cause the same skin infections as methicillin -sensitive strains, they are associated with greater morbidity and mortality because of their resistance to therapy. In addition to HA-MSRA in hospitalized patients with well-known and defined risk factors, there are new CA-MSRA strains which arise in the community or from, animal husbandry sources. These MSRA strains are also a problem in hospitals today. CA-MRSA strains often have special virulence factors, such as Panton Valentine leukocidin), and are often associated with specific often recurrent skin and soft tissue infections (furuncles, abscesses, necrotizing entities).     

淋球菌对头孢曲松的敏感性及淋球菌多抗原测序分型研究

【摘要】 目的 探讨南京市淋球菌对头孢曲松的敏感性以及相应菌株的淋球菌多抗原测序分型（NG-MAST）基因型别。 方法 2007年和2012年在中国疾病预防控制中心性病控制中心临床防治基地分别收集了204株和81株淋球菌,经过分离纯化及鉴定后,用琼脂稀释法测定其对头孢曲松的最小抑菌浓度（MIC）;菌株培养后利用试剂盒提取DNA,并进行淋球菌多抗原测序分型（NG-MAST）。 结果 测试的285株淋球菌MIC ≥ 0.060 μg/ml的菌株比例为63.2%,MIC ≥ 0.125 μg/ml的比例为31.6%。2012年MIC ≥ 0.060 μg/ml和MIC ≥ 0.125 μg/ml的菌株比例分别为44.4%和11.1%,2007年MIC ≥ 0.060 μg/ml和MIC ≥ 0.125 μg/ml的菌株比例分别为70.6%和39.7%。NG-MAST分型研究显示,285株淋球菌共有166个型别,菌株多样性较高,其中73种为已知型别,93种为新型别。2007年测定的所有菌株中以ST568（n = 13）,ST270（n = 9）,ST421（n = 7）,ST2288（n = 5）,ST1731（n = 4）,ST1766（n = 4）,ST1866（n = 4）,ST1870（n = 4）等为主。2012年测定的所有菌株中以ST2318（n = 5）,ST1053（n = 4）,ST5990（n = 4）,ST8726（n = 4）为主。相同NG-MAST型别的菌株具有相同或相近的MIC值。 结论 2012年与2007年菌株的优势型别有较大变化,某些型别与头孢药敏值有较强对应关系。NG-MAST分型可能作为分子生物学标记用于淋球菌耐药监测。     

The Frequency of Erythromycin-Resistant Staphylococcus aureus in Impetiginized Dermatoses

Abstract: A trend toward increasing resistance of Staphylococcus aureus to Standard antibiotic therapy has been reported. Specimens were taken from 98 patients in our outpatient staff clinic who had clinical signs of superficial skin infections. Patients with erythromycin-resistant 5. aureus were contacted by telephone or seen in clinic. The organism was found in 87% of patients. Twenty-two (26%) of the 85 cultures that grew 5. aureus were resistant to erythromycin. Treatment failure occurred in one of these patients. We conclude that S. aureus is the most common causative organism in secondary skin infections and impetigo in our patient popuiation. Despite significant erythromycin resistance, there was a low frequency of treatment faiture in this group, Erythromycin may still be a reasonable agent in the treatment of uncomplicated superficial skin infections in our community at this time.     

Incidence of methicillin-resistant Staphylococcus aureus in community-onset paediatric skin infections: a retrospective study 2000-2005

BACKGROUND: A dramatic increase in the incidence of methicillin-resistant Staphylococcus aureus (MRSA) in community-onset skin infections has been reported over the last 10 years in the USA. The emergence of MRSA has been recently described in France. The aims of this study were to assess the incidence of MRSA in community-onset skin infections and to analyse the characteristics of MRSA skin infections in a French paediatric population. PATIENTS AND METHODS: This is a retrospective study covering the period January 2000 to December 2005. Patients aged under 15 years with S. aureus isolated from skin and a clinical diagnosis of skin infection were included. RESULTS: One hundred and thirty-four children were included with a median age of 3.4 years. There were no significant differences in MRSA prevalence between the different years of the study. The overall prevalence of MRSA was 8.2% (n=11/134). None of the isolated strains presented an antimicrobial susceptibility profile suggestive of the ST80-type community-acquired MRSA described in France. Three MRSA strains were isolated from serious superantigen-mediated skin infections. The antimicrobial susceptibility and genetic profile (tst-positive agr2 MSRA) for one strain of S. aureus militated strongly in favour of an MRSA ST5 clone skin infection. CONCLUSION: In this study we found no evidence of epidemic spread of MRSA in community-onset childhood skin infections between 2000-2005. Nevertheless, we report three cases of serious MRSA-induced superantigen-associated skin infection. This argues in favour of the presence of virulent community MRSA clones in France.     

Antibiotic susceptibility of Staphylococcus aureus strains responsible for community-acquired skin infections

BACKGROUND: The appearance and worldwide spread of community-acquired methicillin-resistant Staphylococcus aureus (MRSA) skin infections warrant new studies of antibiotic resistance among strains of S. aureus responsible for cutaneous infections seen in general practice. PATIENTS AND METHODS: A prospective, multicentre study was performed from December 2003 to August 2004 in outpatients of both sexes presenting with a common bacterial skin infection presumed due to S. aureus (primary or secondary impetigo, ecthyma, paronychia, folliculitis, furunculosis). The investigators (n=50) were GPs from seven French regions. Clinical data (history, previous hospitalisation, type of infection, site, previous treatment, etc.) were collected using a standard questionnaire. A bacteriological sample was taken in attempt to isolate S. aureus after which antibiograms were prepared and minimal inhibiting concentrations determined (11 antibiotics). RESULTS: Four hundred and eighty patients of mean age 42 years (range: 2-94 years) were included. S. aureus was isolated from cultures in 205 of 477 samples, i.e. in 197 patients (eight had two strains of S. aureus). Patients with S. aureus had a primary skin infection in 104/197 cases (53%) (24 impetigo, 20 paronychia, 45 folliculitis or furunculosis) and a secondary infection in 93/197 cases (47%), with 4.9% patients being hospitalized within the preceding six months (median: 10 days). Percentages of resistant S. aureus strains were as follows: penicillin: 86%, erythromycin: 32%, ciprofloxacin: 9.3%, tetracycline: 5.8%, oxacillin: 5.8% (representing MRSA strains), fusidic acid: 4.4%, clindamycin: 3.4%, mupirocin: 1% and gentamicin: 0.5%. All S. aureus strains were sensitive to vancomycin and rifampicin. Except for one strain also resistant to tetracycline and fusidic acid, all MRSA strains were also resistant to ciprofloxacin. DISCUSSION: Multiresistant bacterial strains could become a concern in the community in France in the near future. In our study, only 14/197 (6.8%) S. aureus strains were sensitive to all tested antibiotics, whereas 21/197 (10.7%) were resistant to at least three of them. Compared to a French study performed in private practice in 2000, the level of MRSA is growing only slowly (5.8% versus 3.9%), whereas the percentage of strains of Peni-R/Oxa-S S. aureus are stable (80.5%). CONCLUSION: Common bacterial infections of the skin due to MRSA or to multiresistant S. aureus are not rare in France and have tended to increase slowly in recent years.