Molecular characteristics, risk factors, and clinical outcomes of methicillin-resistant Staphylococcus aureus infections among critically ill pediatric patients in Shanghai, 2016-2021.

IF 2.1 3区 医学 Q2 PEDIATRICS Frontiers in Pediatrics Pub Date : 2024-10-17 eCollection Date: 2024-01-01 DOI:10.3389/fped.2024.1457645
Congyi Dai, Wenting Ji, Yufei Zhang, Weichun Huang, Haiying Wang, Xing Wang
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Abstract

Objective: Methicillin-resistant Staphylococcus aureus (MRSA) infection in children has been on the rise, which poses a serious threat to their health and life in China. The purpose of this study was to determine the molecular characteristics, risk factors, and clinical outcomes of MRSA infections among critically ill pediatric patients.

Methods: A retrospective case-control study was performed in the pediatric intensive care unit (PICU) of a tertiary university teaching hospital. All children infected with culture-positive S. aureus in the PICU between January 2016 and December 2021 were included. Univariate and multivariable logistic regression analyses were used to identify potential risk factors for MRSA infection and clinical outcomes of S. aureus infection. All S. aureus isolates were characterized based on antimicrobial resistance, multilocus sequence typing (MLST) and Staphylococcal protein A (spa) typing.

Results: Of 3,974 patients admitted to the PICU, 280 were diagnosed with a S. aureus infection during the 6-year study period. Among them, 43.2% (121/280) were MRSA. All MRSA isolates showed significantly higher rates of resistance to penicillin, erythromycin, clindamycin and tetracycline than MSSA strains. The MRSA strains consisted of 45 spa types and 20 sequence types (STs) (20 clonal complexes), among which the most frequently represented were ST59-t437and ST398-t034. Multivariable logistic regression revealed vaginal delivery, respiratory failure, co-infection with a virus, C-reactive protein (CRP) > 8 mg/L as significant risk factors for MRSA infection. There was no significant difference in all-cause mortality during hospitalization between the MRSA group and the MSSA group. Furthermore, independent predictors for mortality in patients with S. aureus infections were the presence of hypoproteinemia, hematopathy, septic shock, respiratory failure, fever, and white blood cell (WBC) > 15.0 × 109/L.

Conclusions: The study revealed a high proportion of MRSA infections among critically ill pediatric patients, and found significant risk factors for MRSA infection and poor prognosis of S. aureus infection. Methicillin resistance did not contribute to the mortality in the current study. These findings will provide evidence-based practices to make the strategies of prevention and rational use of antibiotics for pediatric patients with S. aureus infection in the ICU.

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2016-2021年上海儿科重症患者耐甲氧西林金黄色葡萄球菌感染的分子特征、风险因素和临床结局。
研究目的在中国,儿童耐甲氧西林金黄色葡萄球菌(MRSA)感染呈上升趋势,严重威胁着儿童的健康和生命。本研究旨在确定儿科重症患者中 MRSA 感染的分子特征、风险因素和临床结果:方法:在一家三级大学教学医院的儿科重症监护室(PICU)开展了一项回顾性病例对照研究。研究纳入了2016年1月至2021年12月期间在PICU感染金黄色葡萄球菌培养阳性的所有患儿。采用单变量和多变量逻辑回归分析来确定MRSA感染的潜在风险因素和金黄色葡萄球菌感染的临床结局。根据抗菌药耐药性、多焦点序列分型(MLST)和金黄色葡萄球菌蛋白A(spa)分型对所有金黄色葡萄球菌分离物进行特征描述:在 6 年的研究期间,PICU 共收治了 3974 名患者,其中 280 人被确诊为金黄色葡萄球菌感染。其中,43.2%(121/280)为 MRSA。所有 MRSA 分离物对青霉素、红霉素、克林霉素和四环素的耐药率均明显高于 MSSA 菌株。MRSA菌株包括45种Spa类型和20种序列类型(ST)(20个克隆复合体),其中最常见的是ST59-t437和ST398-t034。多变量逻辑回归显示,阴道分娩、呼吸衰竭、合并病毒感染、C反应蛋白(CRP)> 8 mg/L是MRSA感染的重要风险因素。MRSA 组和 MSSA 组在住院期间的全因死亡率方面没有明显差异。此外,低蛋白血症、血液病、脓毒性休克、呼吸衰竭、发热和白细胞(WBC)> 15.0 × 109/L也是金黄色葡萄球菌感染患者死亡的独立预测因素:该研究揭示了儿科重症患者中 MRSA 感染的高比例,并发现了 MRSA 感染的重要风险因素和金黄色葡萄球菌感染的不良预后。在本次研究中,甲氧西林耐药性并未导致死亡率上升。这些研究结果将为重症监护室中金黄色葡萄球菌感染的儿科患者制定预防和合理使用抗生素的策略提供循证实践。
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来源期刊
Frontiers in Pediatrics
Frontiers in Pediatrics Medicine-Pediatrics, Perinatology and Child Health
CiteScore
3.60
自引率
7.70%
发文量
2132
审稿时长
14 weeks
期刊介绍: Frontiers in Pediatrics (Impact Factor 2.33) publishes rigorously peer-reviewed research broadly across the field, from basic to clinical research that meets ongoing challenges in pediatric patient care and child health. Field Chief Editors Arjan Te Pas at Leiden University and Michael L. Moritz at the Children''s Hospital of Pittsburgh are supported by an outstanding Editorial Board of international experts. This multidisciplinary open-access journal is at the forefront of disseminating and communicating scientific knowledge and impactful discoveries to researchers, academics, clinicians and the public worldwide. Frontiers in Pediatrics also features Research Topics, Frontiers special theme-focused issues managed by Guest Associate Editors, addressing important areas in pediatrics. In this fashion, Frontiers serves as an outlet to publish the broadest aspects of pediatrics in both basic and clinical research, including high-quality reviews, case reports, editorials and commentaries related to all aspects of pediatrics.
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