2017-2021 年意大利米兰一家三级儿科医院儿童金黄色葡萄球菌的流行病学和药敏情况。
Epidemiology and antimicrobial susceptibility of Staphylococcus aureus in children in a tertiary care pediatric hospital in Milan, Italy, 2017-2021.
机构信息
University of Milan, Milan, Italy.
Laboratory of Microbiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
出版信息
Ital J Pediatr. 2022 May 7;48(1):67. doi: 10.1186/s13052-022-01262-1.
BACKGROUND
Methicillin-resistant Staphylococcus aureus (MRSA) is highly prevalent worldwide and can cause severe diseases. MRSA is associated with other antibiotic resistance. COVID-19 pandemic increased antimicrobial resistance in adult patients. Only a few data report the antimicrobial susceptibility of S. aureus in the Italian pediatric population, before and during the COVID-19 pandemic.
METHODS
We included all the S. aureus positive samples with an available antibiogram isolated from pediatric patients (< 18 years old) in a tertiary care hospital in Milan, Italy, from January 2017 to December 2021. We collected data on demographics, antimicrobial susceptibility, and clinical history. We compared methicillin-susceptible Staphylococcus aureus (MSSA) and MRSA strains. We calculated the frequency of isolation by year. The incidence of isolates during 2020 was compared with the average year isolation frequency using the univariate Poisson test. We compared the proportion of MRSA isolates during 2020 to the average proportion of other years with the Chi-squared test.
RESULTS
Our dataset included a total of 255 S. aureus isolated from 226 patients, 120 (53%) males, and 106 (47%) females, with a median age of 3.4 years (IQR 0.8 - 10.5). The mean isolation frequency per year was 51. We observed a significant decrease of isolations during 2020 (p = 0.02), but after adjusting for the total number of hospitalization per year there was no evidence that the incidence changed. Seventy-six (30%) S. aureus were MRSA. Twenty (26%) MRSA vs 23 (13%) MSSA (p = 0.02) were hospital-acquired. MRSA strains showed higher resistance to cotrimoxazole, clindamycin, macrolides, levofloxacin, gentamicin, and tetracyclin than MSSA strains. None of MRSA were resistant to linezolid and vancomycin, one was resistant to daptomycin. The proportion of MRSA did not change during the COVID-19 pandemic. The overall clindamycin resistance was high (17%). Recent antibiotic therapy was related to MRSA infection.
CONCLUSION
The proportion of MRSA did not change during the COVID-19 pandemic and remained high. Clindamycin should not be used as an empirical MRSA treatment due to its high resistance.
背景
耐甲氧西林金黄色葡萄球菌（MRSA）在全球广泛流行，可导致严重疾病。MRSA 与其他抗生素耐药性有关。COVID-19 大流行增加了成年患者的抗菌药物耐药性。仅有少数数据报告了意大利儿科人群在 COVID-19 大流行之前和期间金黄色葡萄球菌的抗菌药物敏感性。
方法
我们纳入了意大利米兰一家三级保健医院从 2017 年 1 月至 2021 年 12 月从儿科患者（<18 岁）中分离的所有阳性金黄色葡萄球菌样本，并进行了药敏试验。我们收集了人口统计学、抗菌药物敏感性和临床病史的数据。我们比较了甲氧西林敏感金黄色葡萄球菌（MSSA）和 MRSA 菌株。我们按年份计算了分离率。使用单变量泊松检验比较 2020 年分离株的发生率与平均年分离频率。我们使用卡方检验比较 2020 年与其他年份的 MRSA 分离株比例。
结果
我们的数据集中共包括 255 株金黄色葡萄球菌，来自 226 例患者，其中 120 例（53%）为男性，106 例（47%）为女性，中位年龄为 3.4 岁（IQR 0.8-10.5）。每年的平均分离率为 51。我们观察到 2020 年的分离率显著下降（p=0.02），但在调整每年的总住院人数后，没有证据表明发病率发生了变化。76 株（30%）金黄色葡萄球菌为 MRSA。20 株（26%）MRSA 与 23 株（13%）MSSA 相比（p=0.02）为医院获得性。MRSA 菌株对复方新诺明、克林霉素、大环内酯类、左氧氟沙星、庆大霉素和四环素的耐药率高于 MSSA 菌株。MRSA 菌株均对利奈唑胺和万古霉素敏感，1 株对达托霉素耐药。在 COVID-19 大流行期间，MRSA 的比例没有变化。克林霉素的总体耐药率很高（17%）。最近的抗生素治疗与 MRSA 感染有关。
结论
在 COVID-19 大流行期间，MRSA 的比例没有变化，仍然很高。由于克林霉素耐药率高，不应将其作为经验性 MRSA 治疗药物。
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