儿童皮肤感染金黄色葡萄球菌临床分布、耐药性及皮损特点分析

Analysis of clinical distribution,drug resistance and clinical features of staphylococcus aureus isolated from pediatric skin infections

目的:探讨儿童皮肤软组织感染分离获得的金黄色葡萄球菌的临床分布特征、耐药性和皮损特点。方法:回顾性分析杭州市儿童医院皮肤软组织感染患儿创面分离的299株金黄色葡萄球菌,通过苯唑西林(MIC≥4 mg/L)筛选出耐甲氧西林的金黄色葡萄球菌(MRSA)或甲氧西林敏感的金黄色葡萄球菌(MSSA),对临床分布、耐药性及皮损特点进行归纳。结果:共分离出299株金黄色葡萄球菌,其中脓疱疮121株(40.5%)、皮肤疖痈53株(17.7%)、特应性皮炎26株(8.7%)、湿疹皮炎24株(8.0%),其他均在5%以下。确定为MRSA共76株(25.4%),其中脓疱疮占36.8%;其次是特应性皮炎和皮肤疖痈分别占11.8%和23.7%。在26例特应性皮炎伴皮肤感染患儿中,MRSA和MSSA之间的皮损形态规则和皮损形态不规则比例,差异有统计学意义(P<0.05)。在299株金黄色葡萄球菌中,MRSA有76株,占25.4%;MRSA对青霉素G耐药率为100%,氯洁霉素耐药率74.5%,红霉素耐药率68.4%,复方新诺明耐药率31.6%,四环素耐药率18.4%,对其余抗菌药物耐药率在5%以下。对喹奴普汀/达福普汀、万古霉素、利福平、利奈唑烷、庆大霉素及替加环素全部敏感。结论:儿童皮肤软组织感染中金黄色葡萄球菌中MRSA检出率较高,最常见疾病为脓疱疮、皮肤疖痈和特应性皮炎,其中特应性皮炎中表现为形态规则、界限清楚的皮损更提示MRSA感染,应及早进行分泌物培养,根据结果早期积极治疗,防止导致系统感染。

Objective:To explore the characteristics of clinical distribution,drug resistance,and clinical features of Staphylococcus aureus isolated from pediatric skin and soft tissue infections.Methods:Retrospective analysis was conducted on 299Staphylococcus aureus strains isolated from skin and soft tissue infections in children at the Hangzhou Children's Hospital from January 2019 to April 2022.Methicillin-resistant Staphylococcus aureus(MRSA)or methicillin-sensitive Staphylococcus aureus(MSSA)strains were identified through screening with benzylpenicillin(MIC≥4 mg/L).The clinical distribution,drug resistance,and characteristics of skin rashes were summarized.Results:A total of 299 Staphylococcus aureus strains were isolated,including 121(40.5%)from the patients with impetigo,53(17.7%)from the patients with skin abscesses,26(8.7%)from the patients with atopic dermatitis,and 24(8.0%)from the patients with eczema.Each of the remaining disease categories accounts for less than 5%.Among 299 Staphylococcus aureus strains,76 strains(25.4%)were identified as MRSA,with impetigo being the most common infection,accounting for 36.8%.Atopic dermatitis and skin abscesses accounted for 11.8%and 23.7%,respectively.In 26 cases of atopic dermatitis with skin infections,there were significant differences in the ratio of regular morphology and irregular morphology of the skin lesions between MRSA and MSSA,with statistical significance(P<0.05).Among the 299 Staphylococcus aureus strains,there were 76 MRSA strains,accounting for 25.4%.The resistance rates of MRSA to penicillin G,chloramphenicol,erythromycin,co-trimoxazole,and tetracycline were 100%,74.5%,68.4%,31.6%,and 18.4%respectively,while the resistance rates to other antibiotics were below 5%.All strains were sensitive to quinupristin-dalfopristin,vancomycin,rifampicin,linezolid,gentamicin,and tigecycline.Conclusion:The detection rate of MRSA is high in children with skin and soft tissue infections.The most common infections associated with MRSA are impetigo,skin abscesses,and atopic dermatitis.In particular,the presence of well-defined,regular-shaped lesions in the patients with atopic dermatitis highly suggests the possibility of MRSA infection;it is recommended to promptly obtain secretion culture in these patients for early diagnosis and treatment to prevent systemic infections.