���ɫ��������Ա������ֵ���ҩ���о���mecA������

目的了解杭州地区金黄色葡萄球菌(简称金葡菌)对苯唑西林的耐药情况,探索PCR法检测耐药性相关的mecA基因的敏感性和特异性。方法用金葡菌乳胶凝集试验和Vitek系统GPI卡鉴定金葡菌,用纸片扩散法和E-test法进行药敏试验,并对所有菌株均采用PCR技术检测与耐药性相关的mecA基因。结果Kirby-Bauer法和E-test法检测金黄色葡萄球菌对苯唑西林的敏感性,133株中敏感株分别为113株(85·0%)和115株(86·5%),中介株分别为2株(1·5%)和4株(3·0%),耐药率(株)分别是18株(13·5%)和14株(10·5%);所有菌株均对万古霉素敏感。mecA基因的PCR扩增结果显示:所有的苯唑西林敏感株mecA基因均阴性,中介株mecA基因阳性1株,而所有耐药株均阳性,标准株ATCC25923则为阴性。杭州地区金葡菌对苯唑西林的耐药率为10·5%,以E-test法为金标准,纸片扩散法和PCR法的耐药菌检出的敏感性为100%,而特异性分别为96·6%和98·3%。结论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。     

������θ������80���ٴ��ص㼰Ԥ�����

??Objective To compare the etiologic factors??clinical features and prognosis in newborns with gastrointestinal perforation. Methods A retrospective study of the clinical data from 80 cases with diagnosis of gastrointestinal perforation collected from January 2004 to December 2015 was performed. Based on whether they were full-term??the cases were divided into two groups??then the clinical features??etiologic factors and prognosis were compared. Results Among the 80 neonates with gastrointestinal perforation??there were 62 preterm infants and 18 full-term infants. The main causes of gastrointestinal perforation for the two groups was necrotizing enterocolitis??with the most frequent clinical symptom of abdominal distension.cases. Compared with full-term infants??the incidence of preterm shock??dyspnea??DIC??and poor reaction was significantly higher in preterm infants??P??0.05??.The mean time period of perforation in preterm infants group was 9??1.75??20?? d??while it was 4.5??1??7.75?? d in full-term infants group.There were 62 cases that received surgical treatment??8 cases of which were gastric perforation and 54 cases were intestinal perforation. The exact site of perforation of the 18 cases who refused surgical treatment was not clear. Of all the cases??32 infants died with the overall mortality rate of 40%. For the preterm infants??the mortality was 41.9% ??26 cases????while it was 33.3% ??6 cases?? in the full-term infants group. Conclusion Neonatal gastrointestinal perforation is one of the serious diseases in neonatal period??which has a very high mortality rate. Early diagnosis??active treatment and timely surgical intervention can significantly improve survival rates and improve the prognosis.     

������Σ�ػ���ת�����缰������

??Establishing a regional pediatric transport network is crucial to treatment of critically ill children and implementation of hierarchical medical system. The transport mainly include s communication before transport??assessing and stabilizing patients in local hospital??life support during transport and high quality handoff communication between physicians in receiving hospitals. The transport team members should master the pediatric emergency skills??and the transport equipment and supplies must be in good condition. The transfer center should carry out quality control to improve the quality of transport??and train medical staff in the region and carry out scientific research to improve treatment for critically ill children.     

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。     

金黄色葡萄球菌附属基因调节系统功能缺陷的研究进展

金黄色葡萄球菌是社区获得性感染和医院获得性感染的主要病原菌之一,其致病性是大量的胞外蛋白和细胞壁组分在感染的不同阶段协调表达的结果,附属基因调节子(accessory gene regulator,agr)介导的群体感应机制在其中发挥着重要作用.但是研究发现agr功能缺陷株在临床分离株中广泛存在,该文在简述agr系统的基础上,主要对金黄色葡萄球菌agr系统功能缺陷株在生物膜形成、所致感染性疾病的病程和结局以及抗生素耐药性等方顽的研究进展进行综述.     

新生儿金黄色葡萄球菌皮肤和软组织化脓性感染临床分离株分子及毒力特征

目的 监测新生儿金黄色葡萄球菌（SA）皮肤和软组织化脓性感染（SSTIs）临床分离株的分子和毒力特征,为预防和治疗新生儿SSTIs提供理论依据。方法 收集2015年5月至2016年4月首都医科大学附属北京儿童医院NICU临床诊断为SSTIs的病例,对SA分离株进行agr、MLST、spa 和SCCmec 分型;通过PCR对SA菌株进行21种超抗原毒素基因、sasX、PVL基因检测。结果 44例SSTIs新生儿,男22例,中位年龄4.5（0～22）d,均为社区获得性感染。共分离出13例SA菌株,其中MRSA 7株,MRSA最常见的克隆是agrⅠ-MRSA-ST59-SCCmecⅣa,13株SA包含2～8种超抗原基因型,最常见的毒素基因型为sek-seb-seq,有6株SA PVL基因阳性,均不携带sasX基因。结论 新生儿SSTIs中,SA携带率较低, agrⅠ-MRSA-ST59-SCCmecⅣa-t437是MRSA最主要的流行克隆,SA分离株超抗原基因携带率高。     

Skin and soft tissue infections caused by community‐associated methicillin‐resistant staphylococcus aureus among children in China

Aim: To investigate the characteristic of community‐associated methicillin‐resistant staphylococcus aureus (CA‐MRSA) skin and soft tissue infections (SSTIs) among children in China. Methods: Forty‐seven children with CA‐MRSA SSTIs were enrolled in this study. Clinical information was collected and analysed. The strains from the children were analysed by multilocus sequence typing (MLST), staphylococcus cassette chromosome mec (SCCmec) typing and spa typing. The Panton‐Valentine leukocidin (PVL) gene was also detected. Results: The majority of the 47 cases were impetigo (20; 42.6%) and abscesses (14; 29.8%). The rest was cellulites, infected wounds, omphalitis, paronychia and conjunctivitis combined folliculitis. Thirty‐two of the isolates (68.1%) were PVL‐positive, and the abscesses infected with PVL‐positive strains usually required incision and drainage (87.5% vs. 16.7%, p = 0.026). Most of the isolates belonged to ST type 59, which accounted for 46.8%, followed by ST1 (7/47, 14.9%) and ST910 (5/47, 10.6%). The clone of ST59‐MRSA‐IV with t437 was the most prevalent one. The multiresistant rate of these strains was 93.6%. Conclusion: The most common disease of CA‐MRSA SSTIs was impetigo, and PVL‐positive abscess was associated with incision and drainage. ST59‐MRSA‐IV with t437 was the most prevalent clone, and the multiresistant rate was high in Chinese children.     

���ƽ��ɫ���������Ⱦ�ֿ�����ҩ�׷���

??Abstract??Objective??To investigate the current status of specimen distribution of Staphylococcus aureus isolated??the infection rates and resistance situation of methicillin-resistant Staphylococcus aureus ??MRSA?? and methicillin-sensitive Staphylococcus aureus ??MSSA?? in sick in-patients of children from 2005 to 2009. Methods??A retrospective analysis was made on Staphylococcus aureus detected in 35 352 specimens in Capital Institute of Pediatrics from 2005 to 2009. Results??A total of 463 stains of Staphylococcus aureus was isolated from specimens in sike children and the total detection rate was 1.31%. The top three types of specimens with high detection rates were pus ?? secretion from umbilicus?? eyes and wounds as well as respiratory tract specimen?? such as sputum?? swabs and broncho-alveolar lavage fluids.Their detection rate was 24.26%?? 7.32% and 6.73% respectively. However?? detection rate of blood occupied 0.20% only. In these 463 stains?? MRSA was detected in 48 stains??10.37%??and MSSA was in 415 stains??89.63%??. The detection rates of MRSA increased gradually year by year. Meanwhile?? 92.3% of them were multiple-resistant. Conclusion??MRSA has an increased trend since 2005 in childpatients with infections.It will be more and more important for us to focus on treatment of MRSA infection in pediatrics and monitoring of multiple-resistant MRSA .     

住院新生儿鼻腔和体表定植金黄色葡萄球菌的分子特征及耐药性

背景：金黄色葡萄球菌（SA）在鼻腔和体表的定植可增加新生儿SA感染的风险,了解住院新生儿的SA定植状况、菌株分子型及耐药性有助于制定合理的治疗方案。 目的：探讨NICU患儿入院时体表的SA定植、菌株分子特征及耐药性。 设计：横断面研究。 方法：纳入2020年8月1日至2021年1月31日入住首都医科大学附属北京儿童医院NICU时入院日龄≤28 d且胎龄≥28周的新生儿,收集临床信息。并对入院后12 h 内体表部位采集的拭子进行细菌培养和菌落计数,采用Staphytect Plus试剂盒及PCR扩增nuc基因进行SA菌株鉴定,并分别进行抗生素耐药性检测。 主要结局指标：NICU住院新生儿体表定植的SA分子特征及耐药性。 结果：共纳入766例NICU住院新生儿,其中257例（33.6%）存在≥1个部位的SA定植,单部位、2个部位、≥3个部位SA定植组分别为135例（52.5%）、65例（25.2%）和57例（22.3%）,各组间的临床特征（男婴、入院日龄、剖宫产、入院前纯母乳喂养、入院前应用抗生素、入院时气管插管常频机械通气、住院天数）、菌株分型（MRSA、MSSA）、sarA基因状态差异均无统计学意义,PVL 阳性差异有统计学意义。≥2个部位定植组与1个部位定植组比较,PVL阳性 ［39（32.0%）vs 23(17.0%) ,P=0.005］和sarA 阳性［83（68.0%） vs 56 (41.5%),P<0.01］差异有统计学意义。鼻前庭、脐根部、腋下和腹股沟分别培养出176株、124株、72株和76株,MSSA占比分别为82.4%、77.4%、80.6%和80.3%,各部位SA菌株的MRSA和MSSA占比差异均无统计学意义。MSSA菌株最常见的克隆型为ST398- t309型,MRSA菌株最常见的克隆型为ST59-SCCmecIV-t437。PVL 、sarA和PVL+sarA基因检测阳性株,MRSA和MSSA阳性率差异均无统计学意义。所有的288株SA均对莫匹罗星、利奈唑胺及万古霉素敏感;15株美罗培南不敏感株,其中MRSA 14株（1株耐药,13株中介）,MSSA 1株（中介）;耐药率从高到低依次为青霉素、红霉素、头孢曲松和苯唑西林。 结论：NICU相对病情稳定的新生儿鼻腔和体表皮肤SA定植率为33.6%。≥2个部位定植与1个部位定植相比,PVL和sarA阳性更高。MSSA菌株最常见的克隆型为ST398-t309,MRSA菌株最常见的克隆型为ST59-SCCmecIV-t437。本次研究中所有定植的SA菌株均对莫匹罗星、利奈唑胺及万古霉素敏感,有对美罗培南耐药MRSA分子型菌株检出。     

儿童耐甲氧西林金黄色葡萄球菌感染致严重脓毒症12例分析

目的分析儿童耐甲氧西林金黄色葡萄球菌(MRSA)感染导致严重脓毒症的临床特点及细菌耐药性。方法回顾性分析2010年1月至2013年12月收治的12例MRSA感染致严重脓毒症患儿的病史和细菌药敏试验资料。结果 12例患儿中,男5例、女7例,年龄8 d~11岁,中位年龄1岁,9例为1岁婴儿,均急性起病。5例表现为急性骨髓炎和/或化脓性关节炎,5例表现为坏死性肺炎伴脓胸,1例表现为坏死性筋膜炎,1例表现为血流感染;其中8例同时伴有皮肤及软组织感染,7例并发脓毒性休克,1例并发弥漫性血管内凝血。患儿C反应蛋白均显著升高,4例白细胞计数下降。药敏试验显示12株MRSA对万古霉素、利奈唑胺均敏感,对红霉素、克林霉素、复方磺胺甲噁唑有不同程度的耐药。经手术清创、胸腔闭式引流等治疗后,8例存活,4例死亡。结论 MRSA感染导致的严重脓毒症多见于婴儿,发病急、进展迅速,需要积极治疗。     

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.     

Prevention of methicillin-resistant Staphylococcus aureus infections in neonates

Reports of methicillin-resistant Staphylococcus aureus (MRSA) infection in neonatal intensive care units (NICU) and normal newborn nurseries in Japan were investigated, and various methods of preventing transmission were evaluated. In the late 1980s, MRSA which had spread in adult wards also invaded NICU. Very low birthweight or premature infants had become the targets of MRSA infection and this has now become a serious problem. Recent reports have revealed that 87% of major NICU in Japan have suffered from MRSA infections. However, we have found that preventive measures can greatly reduce the risk of a newborn being infected by a carrier, while also controlling the disease caused by MRSA infection. Recently, MRSA infections in normal newborn nurseries have also become a serious problem in pediatric departments. Methicillin-resistant Staphylococcus aureus which can colonize in the newborn baby just after birth, is passed on to the newborn by carrier medical staff. It was found to be of great importance that infant's mothers hold and nurse their babies immediately after birth, and start breast-feeding while still in the delivery room. Furthermore, the most appropriate and ideal newborn nursery is one where mother and child are roomed together and there is little intervention by the hospital. In neonatal care, it is of utmost importance to treat carriers of MRSA bacteria, and to inhibit the spread of the bacterium in babies by taking standard precautionary measures.