金黄色葡萄球菌成人与儿童感染株体外抗菌活性的比较

目的：了解金黄色葡萄球菌(简称金葡菌)的成人感染株与儿童感染株在体外抗菌活性的差异。方法：采用血浆凝固酶、金葡菌单克隆抗体及Vitek-32型仪进行菌株鉴定,纸片琼脂扩散法(K-B法)对84株儿童感染株及74株成人感染株进行药物敏感性试验,耐甲氧西林金葡菌（MRSA）的检测采用头孢西丁纸片法。结果：成人感染株与儿童感染株的MRSA发生率分别为47%和8%,两者之间差异有显著性(P<0.01);所有菌株对万古霉素敏感,所有儿童感染株对夫西地酸敏感;成人感染株与儿童感染株对头孢唑啉、头孢呋辛、头孢西丁、庆大霉素及左氧氟沙星的耐药率差异有显著性（P<0.01）。结论：金葡菌成人感染株较儿童感染株耐药和多重耐药性严重,临床医生应针对不同感染人群合理使用抗菌药物。［中国当代儿科杂志,2009,11（12）：961-963］     

夫西地酸治疗新生儿葡萄球菌感染的疗效观察

目的观察夫西地酸治疗新生儿葡萄球菌感染的临床疗效及不良反应。方法选择2008—2011年本院新生儿科收治、确诊葡萄球菌感染并应用夫西地酸治疗的新生儿病例,观察患儿临床疗效,同时监测黄疸及肝肾功能。结果共53例患儿经痰液、血液、脑脊液、皮肤渗液、尿液、粪便等标本培养确诊葡萄球菌感染应用夫西地酸治疗,其中表皮葡萄球菌12例,金黄色葡萄球菌12例,溶血性葡萄球菌25例,耐甲氧西林金黄色葡萄球菌4例;痊愈30例,显效17例,进步3例,无效3例,总有效率88.7%;无一例出现肝肾功能异常及黄疸程度加重。结论观察夫西地酸治疗新生儿葡萄球菌感染的临床疗效好,无肝肾功能损害,具有临床应用前景。     

金黄色葡萄球菌感染及耐药性探讨

目的 了解金黄色葡萄球菌（SA）感染趋势及耐药分析。方法 对我院1993-2001年确诊为SA感染的病例进行统计分析。结果 SA感染呈下降趋势，耐甲氧西林金葡菌（MRSA）感染有所增加，SA最易致多器官感染，其中肺部感染最常见，尚未发现万古霉素耐药的病例。结论 MRSA已成为重要的感染菌群，选择适当的抗生素治疗SA感染非常重要。     

北京地区儿童脓疱疮来源金黄色葡萄球菌耐药性分析

目的分析儿童脓疱疮来源的金黄色葡萄球菌(简称金葡菌)耐药趋势,为治疗儿童脓疱疮提供理论依据。方法对2003年6月-2007年12月就诊于本科门诊的脓疱疮患儿皮损分泌物分离的金葡菌,应用琼脂稀释法药敏试验检测14种抗生素对分离的金葡菌的耐药率,应用WHONET 5.3软件对药敏结果进行分析。结果 984株金葡菌对14种抗生素的药敏试验结果显示,耐药率前3位依次为青霉素、红霉素和克林霉素,其中金葡菌对青霉素的耐药率连续5 a均超过92.0%,对红霉素耐药率均高于80.0%,明显高于其他药物。氯霉素、庆大霉素和四环素耐药率相对稳定,未见明显增减。甲氧西林、头孢菌素和环丙沙星的耐药率相对较低,未超过5.0%;耐甲氧西林金葡菌的发生率低于2%,仅发现1株莫匹罗星耐药菌株,未发现万古霉素和夫西地酸耐药菌株。结论北京地区儿童脓疱疮来源的社区获得性耐甲氧西林金葡菌分离率较低。青霉素、红霉素、克林霉素和四环素等药物在本地区已不适于治疗金葡菌感染的脓疱疮。虽然金葡菌对氯霉素、庆大霉素和环丙沙星敏感性较好,但是鉴于这3类抗生素的不良反应对儿童的影响,应用时应严格掌握其临床适应证。莫匹罗星、夫西地酸、万古霉素和头孢菌素可作为治疗脓疱疮的局部或全身首选用药。     

儿童金黄色葡萄球菌肺炎52例临床分析

目的 了解金黄色葡萄球菌肺炎(SAP)在儿童中的发病现状及耐药性。方法 回顾分析了重庆医科大学儿童医院PICUl993—2003年确诊为金黄色葡萄球菌肺炎52例的发病、抗生素敏感性和预后情况。结果 SAP临床表现无特殊性，SA最易致多器官感染，尚未发现万古霉紊耐药的病例。结论 SAP临床表现无特殊性，容易出现并发症，细菌具有多重耐药，因此选择适当的抗生察对治疗SAP感染非常重要。     

金黄色葡萄球菌儿童株耐药性研究和mecA基因检测

目的了解金黄色葡萄球菌（简称金葡菌）儿童株对常用抗生素的耐药特点,评价苯唑西林耐药性相关基因raecA-PCR的临床价值。方法用金葡菌乳胶凝集试验和Vitek系统GPI卡鉴定金葡菌,用纸片扩散法完成12种常用抗生素的药敏试验,同时用E-test法进行苯唑西林和万古霉素耐药性检测,并对所有菌株采用PCR技术检测mecA基因。结果金黄色葡萄球菌共259株,包括185株临床株和74株健康携带株,其中95．8％的菌株产生B内酰胺酶而对青霉素G耐药,91．1％的菌株对苯唑西林敏感,对头孢噻肟和头孢曲松的敏感率均为91．9％;对红霉素、四环素、克林霉素、甲氧苄啶磺胺甲基异恶唑、氯霉素、氧氟沙星和利福平的耐药率分别为48．3％、30．9％、21．6％、11．2％、10．0％、2．3％和1．5％;所有菌株均对万古霉素敏感。临床株对苯唑西林、头孢噻肟和头孢曲松的耐药率高于携带株（P〈0．05）,对红霉素的耐药率低于携带株（P〈0．01）。mecA-PCR结果显示：标准株ATCC25923和所有苯唑西林敏感株mecA基因均阴性,中介株mecA基因阳性1株,耐药株中均阳性。结论本研究中金葡菌对苯唑西林的耐药率不高,而mecA-PCR技术可以作为快速检测耐苯唑西林金葡菌的有效方法。     

成都地区儿童金黄色葡萄球菌定植/感染分离株的流行病学研究

目的调查成都地区儿童金黄色葡萄球菌定植/感染分离株的流行病学特征。方法 2004年1月—2009年4月,以成都市健康儿童、门诊呼吸道感染患儿和金黄色葡萄球菌感染住院患儿为研究对象,采集鼻拭子或感染部位标本进行培养,并对分离的金黄色葡萄球菌进行药敏实验,应用PCR方法检测菌株的PVL毒力基因和mecA耐药基因,对菌株进行多位点序列分析(MLST)。结果培养分离金黄色葡萄球菌定植株174株、感染株51株。门诊呼吸道感染患儿金葡菌的多重耐药率分别为,定植株59.3%,感染株52.9%;PVL基因阳性率分别为,定植株55.6%(15/27),感染株80.4%(41/51);mecA耐药基因阳性率分别为,定植株11.1%(3/27),感染株62.7%(32/51)。对健康儿童定植株以及感染株进行MLST分析,共发现33个ST类型,定植株以ST121、ST59和ST398为主,感染株以ST121、ST88和ST398为主;这些菌株属于15个克隆类型,以CC121、CC59和CC398为主。结论成都地区儿童金黄色葡萄球菌定植和感染分离株具有较高的PVL毒力基因和mecA耐药基因携带率,具有明显不同于其他地区的独特的遗传背景。     

儿童金黄色葡萄球菌播散感染14例临床分析

目的总结儿童金黄色葡萄球菌播散感染(DSAI)的临床特点及治疗。方法回顾分析2006年1月至2013年12月住院治疗的14例DSAI患儿的临床表现、治疗及转归资料。结果 14例DSAI患儿均为社区获得性感染,起病中位年龄15个月(6 d~13岁),男女各半;患儿均有发热,除发热外的首发症状为皮肤软组织感染6例,肢体、关节肿痛5例;白细胞计数、C反应蛋白明显升高。化脓性感染部位为皮肤软组织者12例(85.7%)、肺部12例(85.7%)、骨骼4例、关节3例、中枢神经系统3例、心包1例;其中皮肤软组织合并肺部感染10例(71.4%)。9例行皮肤软组织脓肿切排术,3例行关节清创后封闭负压引流(VSD)术,3例行骨髓炎病灶清除后VSD术,3例行胸腔闭式引流术。所有患儿均使用万古霉素和/或利奈唑胺抗感染,5例辅以利福平,11例联合丙种球蛋白调节免疫治疗。12例(85.7%)临床治愈及好转。结论皮肤软组织、骨骼及关节感染是DSAI的主要诱发因素;在应用有效抗生素基础上,辅以丙种球蛋白可能有更佳效果。     

儿童金黄色葡萄球菌肺炎52例临床分析

目的 了解金黄色葡萄球菌肺炎(SAP)在儿童中的发病现状及耐药性。方法 回顾分析了重庆医科大学儿童医院PICU1993-2003年确诊为金黄色葡萄球菌肺炎52例的发病、抗生素敏感性和预后情况。结果SAP临床表现无特殊性,SA最易致多器官感染,尚未发现万古霉素耐药的病例。结论 SAP临床表现无特殊性,容易出现并发症,细菌具有多重耐药.因此选择适当的抗生素对治疗SAP感染非常重要。     

儿童吸入性和血源性金黄色葡萄球菌肺炎临床特点及其致病株耐药性分析

目的 比较吸入性和血源性金黄色葡萄球菌肺炎（Staphy1ococcus aureus pneumonia, SAP）的临床特点及分离菌株的耐药性。方法 回顾分析该院2008 年1 月至2013 年12 月确诊为SAP 的44 例患儿的临床资料。44 例患儿中,24 例为吸入性感染,20 例为血源性感染。结果 吸入性SAP 以3 岁以下婴幼儿多见,血源性SAP 以6 岁以上儿童多见。吸入性SAP 患儿咳嗽、喘息、湿罗音、呼吸困难和脓胸发生率显著高于血源性感染者（P<0.05）,而血源性SAP 患儿高热、意识障碍、肝肾功能异常、化脓性骨髓炎、化脓性关节炎、脓毒血症和皮肤软组织脓肿发生率更高（P<0.05）。吸入性SAP 分离株对阿莫西林/ 棒酸、苯唑西林和头孢西丁耐药率显著高于血源性SAP 分离株,血源性SAP 分离株复方新诺明耐药率更高（P<0.05）。结论 吸入性SAP 好发于3 岁以下婴幼儿,呼吸道症状体征突出;血源性SAP 好发于6 岁以上儿童,感染中毒症状重,易致多器官感染和脏器功能损害。吸入性与血源性SAP 分离株的抗菌谱有差异。     

Antimicrobial susceptibility of Staphylococcus aureus in children with atopic dermatitis

Background: Skin infection and/or nasal carriage of Staphylococcus aureus in children with atopic dermatitis (AD) is a risk factor for exacerbating disease or subsequent recurrent S. aureus infection. The purpose of the study is to evaluate the antibiotic susceptibilities of S. aureus strains from AD children and determine the most appropriate choice of antibiotics. Methods: Nasal swabs from 168 healthy children with AD and 20 AD children with concurrent skin and soft‐tissue infections (SSTI) were collected in 2005–2008. S. aureus strains were further analyzed for and compared with antibiotic susceptibilities. Results: There were 78 (46.4%) healthy children with AD colonized with S. aureus, and 24 (30.8%) were methicillin‐resistant S. aureus (MRSA). Among the 20 SSTI‐infecting strains, 12 (60%) were MRSA. Antimicrobial susceptibility testing showed that, after penicillin, colonizing and SSTI‐infecting strains had the highest rates of resistance to erythromycin (50% and 70%, respectively). All isolated strains were susceptible to vancomycin, rifampin, and mupirocin. Multi‐drug resistance was found in 70% of the colonizing and 50% of the SSTI‐infecting strains. D‐test assay revealed inducible clindamycin resistance in 75% of the colonizing strains. The most prevalent resistance gene was ermB which was present in 94.9% and 92.9% of colonizing and SSTI‐infecting strains, respectively. Conclusions: This study found that colonizing and SSTI‐infecting strains of S. aureus from AD children had a high prevalence of MRSA and multi‐drug resistance. Trimethoprim‐sulfamethoxazole, rifampin, fusidic acid and mupirocin appear to be more suitable for treatment and decolonization of S. aureus in AD children.     

小儿社区获得性耐甲氧西林金黄色葡萄球菌感染临床分析

目的：研究小儿社区获得性耐甲氧西林金黄色葡萄球菌(MRSA)感染的临床特征和耐药情况,以指导临床治疗。方法：以同期分离的医院获得性感染的MRSA菌株作对照,分析该院2002年1月至2005年3月从临床各类标本中分离的社区获得性MRSA菌株的临床特征和耐药情况。结果：25株MRSA占同期分离的全部金黄色葡萄球菌512株的4.7%,其中社区获得性感染的MRSA20例,医院获得性感染的MRSA5例。两组发病年龄无统计学差异。MRSA占金黄色葡萄球菌检出率在连续2年多的时间内呈逐年增多趋势,2003年3.1%、2004年5.4%、2005年第一季度7.2%。两组对多种抗生素敏感实验结果及多重耐药比较均无统计学差异。两组中所有菌株对万古霉素均敏感,未发现万古霉素中介和耐药菌株。医院感染组合并基础疾病比例明显高于社区获得性感染组(P<0.05)。3例社区获得感染组的肺炎患者,痰培养获得MRSA,其中1例给予非敏感抗生素治愈。结论：小儿社区获得性MRSA感染呈上升趋势,其临床和耐药特征与医院感染者未见明显差别。     

Antimicrobial susceptibility of skin-colonizing S. aureus strains in children with atopic dermatitis

Children with atopic dermatitis (AD) are prone to recurrent cutaneous and occasional systemic infections caused by Staphylococcus aureus. Antibiotic therapy represents an important component of the overall management of AD, especially during exacerbations of disease. Erythromycin is still widely used as a first-line antibiotic for this indication. We studied 115 consecutive children (mean age: 2.7 yr, range: 0.2-15) with moderate to severe AD (mean SCORAD: 43.2, range: 16-77) presenting to our outpatient department. Staphylococcus aureus was isolated from 100 of 115 (87%). Antimicrobial susceptibility testing revealed resistance against erythromycin in 18 and against roxithromycin in 19%, respectively. Six percentage of the strains were resistant or only intermediately susceptible to fusidic acid, 13% to amoxicillin and 1% to clindamycin. All strains isolated were susceptible to oxacillin, amoxicillin/clavulanic acid, cefadroxil and cefuroxim. The high rate of primary resistance to macrolides should be born in mind when starting antibiotic therapy in children with AD. Since Gram-positive cocci represent the only relevant microbial agents in AD, first generation cephalosporins such as cefadroxil, whose antimicrobial spectrum is basically restricted to Gram-positive bacteria, would appear to be the ideal first-line antibiotics for the treatment of bacterial superinfections.     

Staphylococcus aureus bacteraemia in children: a 5-year retrospective review

OBJECTIVE: The clinical presentation of Staphyloccocus aureus bacteraemia has been well described in adults, but there is a paucity of published data on the presentation of S. aureus bacteraemia in children. This review sought to compare the presentation of S. aureus in children with that of adults. METHODS: We conducted a 5-year retrospective chart review of S. aureus bacteraemia at the Royal Alexandra Hospital for Children between 1994 and 1998. RESULTS: Of the 140 episodes of S. aureus bacteraemia, 53% were community acquired and 47% nosocomially acquired. The clinical presentation of S. aureus bacteraemia in the children in the present study differed significantly from published studies of adult patients. Of children with community-acquired bacteraemia without pre-existing medical conditions, 59% had a bone or joint infection, which is higher than adult series. Endocarditis has been associated with up to 30% of community-acquired bacteraemia in adults but was much less frequent (1.4%) in the present study. Despite the infrequent use of empiric antibiotic therapy (34% of episodes), the case fatality rate (1.4%) was significantly lower than the published literature relating to adults (11-32%). CONCLUSION: The present study highlights the differences between S. aureus bacteraemia in adults and children.     

儿童社区获得性耐甲氧西林金黄色葡萄球菌感染研究

目的 探讨上海地区儿童社区获得性耐甲氧西林金黄色葡萄球菌(CA-MRSA)的流行状况、临床特征、耐药谱和分子学特征.方法 总结2005年1月至2007年1月上海交通大学附属儿童医院收治社区发生MRSA感染的流行病学和临床资料,进行细菌耐药监测及分子学检测;分析本地区儿童CA-MRSA感染现状、发展趋势.结果 在金黄色葡萄球菌感染患儿中MRSA检出率从7.5%增高至9.7%,其中CA-MRSA占MRSA的10.9%,而卫生保健相关性MRSA(HCA-MRSA)为65.2%.MRSA检出率有一定的季节分布.呼吸科和儿童重症监护病房的HCA-MRSA阳性最高(20%),CA-MRSA在外科较多(40%).CA-MRSA皮肤软组织感染比例最高为40%,HCA-MRSA以肺炎和败血症为主(52%和36%).HCA-MRSA危险因素主要是卫生保健机构接触和使用抗生素(64%),而医院获得性MRSA(HA-MRSA)以插管和机械通气为多见(4%).30株MRSA mecA基因均为阳性.其基因型SCCmec Ⅱ型6株,SCCmecⅢ型15株,SCCmecⅣa型1株和SCCmecⅤ型2株,未能分型6株.PVL基因阳性11例,CA-MRSA均携带PVL基因.12株MRSA的spa基因中有3株(25.0%)完全相同.非多药耐药MRSA为17%,多药耐药MRSA对红霉素和克林霉素均达80%.结论 上海地区儿童社区发生的MRSA感染增多,应引起儿科医师重视.儿童HCA-MRSA主要表现为呼吸道疾病和败血症;CA-MRSA除了可引起皮肤软组织感染外,也可引起重症肺炎和败血症.上海地区儿童MRSA菌株以SCCmecⅢ为主,CA.MRSA以SCCmecⅤ和未能分型株稍多.spa基因的多样性提示目前本地儿童MRSA并非流行株,需要作进一步连续耐药监测.     

Changing trend in antimicrobial resistance of pediatric uropathogens in Taiwan

Background: There is growing concern regarding antimicrobial resistance worldwide, particularly of Escherichia coli, and the first choice of an antimicrobial agent for empiric treatment of pediatric urinary tract infection (UTI) is not well established. Methods: The medical records from January 1991 to December 2005 for all children under 18 years of age admitted to Tri‐Service General Hospital, Taipei for their first UTI were reviewed. Two study periods, early (1991–2000) and late (2001–2005), were chosen during the 15 year period for evaluating the trend of antimicrobial resistance. Results: Of the 368 isolates, E. coli was the most common pathogen (81.0%), followed by Klebsiella pneumoniae (6.5%), Enterococcus spp. (6.0%), and Proteus mirabilis (3.5%). Of the 368 isolates, 77.4% were resistant to ampicillin, 44.6% to co‐trimoxazole, 27.2% to cephalothin, 15.0% to gentamicin, and 8.4% to nitrofurantoin. In the early (1991–2000) and late (2001–2005) study periods, 199 isolates (54.1%) and 169 isolates (45.9%), respectively, were compared. The resistance to antimicrobial agents for overall pathogens in the early and late study periods, respectively, was as follows: 68.8% and 88.0% to ampicillin, 48.9% and 46.6% to co‐trimoxazole, 26.8% and 28.9% to cephalothin, 16.2% and 19.8% to gentamicin, and 8.7% and 9.0% to nitrofurantoin. Conclusion: Among commonly used antimicrobial agents for the treatment of pediatric UTI, there is a trend towards increasing resistance to ampicillin and a persistently low resistance rate to gentamicin, cephalosporin, and nitrofurantoin. Parenteral first‐generation cephalosporins, gentamicin, and oral nitrofurantoin should be considered for first‐line agents, given the resistance patterns of this study.     

儿童泌尿系感染病原菌分布及耐药性10年变迁

目的了解近10年间广州市儿童医院泌尿系感染患儿病原菌的分布及耐药性变迁。方法回顾性分析我院2001—2003年、2011—2013年泌尿系感染患儿尿培养及药敏试验结果。结果近10年间革兰阴性菌与阳性菌的比例无明显变化,大肠埃希菌仍是引起儿童泌尿系感染的主要细菌;2011—2013年肠球菌的检出率为18.3%,较2001—2003年(7.5%)增多,差异有统计学意义(P0.01),已成为第二位致病菌。产ESBLs菌株的分离率,2011—2013较2001—2003明显增高,差异有统计学意义(P0.01)。近10年间大肠埃希菌对亚胺培南的敏感率一直保持在100%,对加酶抑制剂抗生素和呋喃妥因亦有较好的敏感性。不同种属的肠球菌对抗生素的敏感性不同。结论儿童泌尿系感染病原菌的分布和耐药性在不断变化,应密切关注本地区及本院流行病学变化,合理应用抗菌药物。     

Pleuropulmonary complications of PVL-positive Staphylococcus aureus infection in children

It is increasingly recognized world-wide that Panton-Valentine leukocidin (PVL)-positive Staphylococcus aureus (PVL-SA) is associated with a highly aggressive and often fatal form of community-acquired pneumonia. We report four children who presented with severe pleuropulmonary complications due to infection by community-acquired methicillin-sensitive
S. aureus (CA-MSSA), producing PVL toxin. The complications included bilateral multilobular infiltrates, pneumatocoeles, recurrent pneumothoraces, pleural effusion, empyema, lung abscess and diaphragmatic paralysis. This case series highlights the diverse pleuropulmonary manifestations of this potentially lethal infection and the importance of heightened awareness, early recognition and aggressive therapy.
Conclusion:  Complicated pneumonia in a previously fit young patient with a history of preceding 'flu-like' illness or skin/soft tissue infection should raise the suspicion of infection by PVL-positive Staphylococcus aureus (PVL-SA). Severe pleuropulmonary complications are a feature of this disease.     

儿童尿路感染病原菌10年变迁及耐药分析

目的探讨近十年来小儿尿路感染病原菌的变迁及常见致病菌的耐药性。方法对1995年1月～2004年12月185例尿路感染患儿的尿液行细菌培养,采用VITEK全自动微生物鉴定仪进行菌株鉴定及药敏试验。结果共检出菌株196株,以革兰阴性菌为主（占76.5%）,大肠杆菌最多见（占51.0%）,革兰阳性球菌占19.9%。比较前后5年革兰阳性菌检出率,两组差异有统计学意义（χ^2=4.456,P=0.035）。常见革兰阴性菌（大肠杆菌和肺炎克雷伯杆菌）对抗菌药物的敏感性依次为亚胺培南、哌拉西林/他巴唑、头孢哌酮/舒巴坦、庆大霉素、丁胺卡那霉素、呋喃妥因、头孢他啶、头孢噻肟、诺氟沙星、头孢三嗪、阿莫西林/棒酸等,耐药率少于50%;而对氨苄西林、头孢唑啉的耐药率超过50%。常见革兰阳性菌（肠球菌）对常用抗菌药物的敏感性依次为万古霉素、庆大霉素、丁胺卡那霉素、诺氟沙星、SMZco;对青霉素、苯唑西林、红霉素以及头孢唑啉的耐药率均在70%以上。比较前后5年常见细菌对不同抗生素的耐药率变化,大肠杆菌对氨苄青霉素和头孢唑啉的耐药率分别为：78.8%vs93.8%（χ^2=4.605,P=0.032）和36.5%vs58.3%（χ^2=4.760,P=0.029）,差异有统计学意义。结论小儿尿路感染病原以革兰阴性菌占优势,但革兰阳性菌有增加趋势;氨苄青霉素、头孢唑啉已不能作为小儿尿路感染的首选用药;及时监测病原菌变化及耐药趋势以指导临床用药至关重要。