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首页> 外文期刊>Pediatrics: Official Publication of the American Academy of Pediatrics >Severe Staphylococcal sepsis in adolescents in the era of community-acquired methicillin-resistant Staphylococcus aureus.
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Severe Staphylococcal sepsis in adolescents in the era of community-acquired methicillin-resistant Staphylococcus aureus.

机译：在社区获得性耐甲氧西林金黄色葡萄球菌时代，青少年出现严重的葡萄球菌败血症。

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OBJECTIVE: More than 70% of the community-acquired (CA) staphylococcal infections treated at Texas Children's Hospital are caused by methicillin-resistant Staphylococcus aureus (MRSA). Since September 2002, an increase in the number of severely ill patients with S aureus infections has occurred. This study provides a clinical description of severely ill adolescent patients and an analysis of their isolates using molecular methods. METHODS: We identified adolescent patients meeting criteria for severe sepsis requiring admission to the PICU. Patient records were reviewed, and isolates were obtained for susceptibility testing and DNA extraction. Isolates were tested for the presence of virulence genes (cna, tst, lukS-PV, and lukF-PV) and enterotoxin genes (sea, seb, sec, sed, seh, and sej) by polymerase chain reaction. Genomic fingerprints were determined by repetitive-element polymorphism polymerase chain reaction and pulse-field gel electrophoresis. SCCmec cassette type was determined. RESULTS: Fourteenadolescents with severe CA S aureus infections were identified between August 2002 and January 2004. All were admitted to the PICU with sepsis and coagulopathy. Twelve patients had CA-MRSA infections; 2 had CA methicillin-susceptible Staphylococcus aureus (MSSA) infections. The mean age was 12.9 years (range: 10-15 years). Thirteen patients had pulmonary involvement and/or bone and joint infection; 10 patients had > or =2 bones or joints infected (range: 2-10); 4 patients developed vascular complications (deep venous thrombosis); and 3 patients died. All isolates were identical or closely related to the previously reported predominant clone in Houston, Texas (multilocus sequence type 8, USA300), and carried lukS-PV and lukF-PV genes as well as the SCCmec type IVa cassette (12 MRSA isolates) but did not contain cna or tst. Only 1 strain carried enterotoxin genes (sed and sej). CONCLUSIONS: Severe staphylococcal infections in previously healthy adolescents without predisposing risk factors have presented more frequently at Texas Children's Hospital since September 2002. CA MRSA and clonally related CA MSSA characterized as USA300 and sequence type 8 have been isolated from these patients.
机译：目的：在得克萨斯儿童医院治疗的社区获得性（CA）葡萄球菌感染中，有70％以上是由耐甲氧西林的金黄色葡萄球菌（MRSA）引起的。自2002年9月以来，重症患者感染金黄色葡萄球菌的人数有所增加。这项研究提供了重症青少年患者的临床描述，并使用分子方法对其分离物进行了分析。方法：我们确定了符合重症脓毒症标准且需要入住PICU的青春期患者。审查患者记录，并获得分离物用于药敏试验和DNA提取。通过聚合酶链反应测试分离物是否存在毒力基因（cna，tst，lukS-PV和lukF-PV）和肠毒素基因（sea，seb，sec，sed，seh和sej）。通过重复元素多态性聚合酶链反应和脉冲场凝胶电泳确定基因组指纹。确定了SCCmec盒式磁带。结果：在2002年8月至2004年1月之间，发现了十四名患有严重的CA S金黄色葡萄球菌感染的青少年。所有这些人均因败血症和凝血病入院。 12名患者患有CA-MRSA感染; 2例患有CA甲氧西林敏感性金黄色葡萄球菌（MSSA）感染。平均年龄为12.9岁（范围：10-15岁）。 13名患者有肺部受累和/或骨骼和关节感染。 10名患者的骨头或关节感染≥2个（= 2-10）; 4例患者出现血管并发症（深静脉血栓形成）; 3例患者死亡。所有分离株与先前报道的德克萨斯州休斯顿市的优势克隆（多位点序列类型8，USA300）相同或密切相关，并带有lukS-PV和lukF-PV基因以及SCCmec IVa型盒（12个MRSA分离株），但不包含cna或tst。仅1个菌株携带肠毒素基因（sed和sej）。结论：自2002年9月以来，得克萨斯州儿童医院就更频繁地出现以前健康的青少年中严重葡萄球菌感染的情况，而没有易患危险因素。从这些患者中分离出了CA MRSA和特征在于USA300和序列类型8的克隆相关CA MSSA。

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