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BMC Pediatrics
Published in: BMC Pediatrics 1/2018

Open Access 01-12-2018 | Research article

Molecular characterization and antimicrobial susceptibility of Staphylococcus aureus isolated from children with acute otitis media in Liuzhou, China

Authors: Yan Ling Ding, Jinjian Fu, Jichang Chen, Sheng Fu Mo, Shaolin Xu, Nan Lin, Peixu Qin, Eric McGrath

Published in: BMC Pediatrics | Issue 1/2018

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Abstract

Background

There have been few studies focused on the prevalence, bacterial etiology, antibiotic resistance, and genetic background of Staphylococcus aureus (S. aureus) in children with acute otitis media (AOM) in China.

Methods

A retrospective study was conducted in Liuzhou Maternity and Child Healthcare Hospital. Patients younger than 18 years diagnosed with AOM were enrolled in the study. Middle ear fluid specimens were collected and cultured for bacterial pathogens. The antibiotic susceptibility, virulence genes, macrolide resistant genes and sequence types of S. aureus were identified.

Results

From January 1, 2013 to December 31, 2015, a total of 228 cases of AOM were identified. Pathogenic bacteria were positive in 181 (79.4%) of 228 specimens. Streptococcus pneumoniae was the most common bacteria (36.4%), followed by S. aureus (16.2%). Among the 37 S. aureus isolates, 12 (23.5%) were methicillin-resistant S. aureus (MRSA), and 25 (77.5%) were methicillin-susceptible S. aureus (MSSA). A total of 23 isolates (62.2%) were resistant to erythromycin, 40.5% of isolates were resistant to clindamycin, and 37.8% isolates were resistant to tetracycline. Twenty-three isolates were multi-drug resistant (MDR) S. aureus. Eighteen isolates carried the pvl gene. Up to 22 (59.4%) isolates expressed ermA gene, 8 (21.6%) isolates expressed both ermA and ermC genes, and only 8.1% expressed ermB. Among all S.aureus isolates, 7 sequence types (STs) were identified by multilocus sequence typing (MLST). The most common ST was ST59 (16/37, 43.2%), followed by ST45 (7/37, 18.9%) and ST30 (7/37, 18.9%). The predominant MSSA isolates were ST59-t437-MSSA (5/25, 20.0%), the prevailing MRSA isolates were Taiwan related strains ST59-SCCmec-IVa/V (5/12, 41.6%).

Conclusions

S. aureus was the second most common cause for AOM in children in Liuzhou. Most of the S. aureus was MDR which carried a high proportion of ermA and ermC gene. CA-MRSA (ST59-SCCmec-IV/V-t437) is circulating in children with AOM. These findings support continued surveillance of S. aureus infections in children with AOM in both communities and hospitals.
Literature
1.
Vergison A, Dagan R, Arguedas A, Bonhoeffer J, Cohen R, Dhooge I, et al. Otitis media and its consequences: beyond the earache. Lancet Infect Dis. 2010;10(3):195–203.PubMedCrossRef
2.
Ding Y, Geng Q, Tao Y, Lin Y, Wang Y, Black S, et al. Etiology and epidemiology of children with acute otitis media and spontaneous otorrhea in Suzhou, China. Pediatr Infect Dis J. 2015;34(5):e102–6.PubMedCrossRef
3.
Chen YJ, Hsieh YC, Huang YC, Chiu CH. Clinical manifestations and microbiology of acute otitis media with spontaneous otorrhea in children. J Microbiol Immunol Infect. 2013 Oct;46(5):382–8.PubMedCrossRef
4.
Yao KH, Yang YH. Streptococcus pneumoniae diseases in Chinese children: past, present and future. Vaccine. 2008 Aug 18;26(35):4425–33.PubMedCrossRef
5.
Casey JR, Pichichero ME. Changes in frequency and pathogens causing acute otitis media in 1995-2003. Pediatr Infect Dis J. 2004 Sep;23(9):824–8.PubMedCrossRef
6.
Moran GJ, Krishnadasan A, Gorwitz RJ, Fosheim GE, McDougal LK, Carey RB, et al. EMERGEncy ID net study group. Methicillin-resistant S. aureus infections among patients in the emergency department. N Engl J Med. 2006;355(7):666–74.PubMedCrossRef
7.
Maree CL, Daum RS, Boyle-Vavra S, Matayoshi K, Miller LG. Community-associated methicillin-resistant Staphylococcus aureus isolates causing healthcare-associated infections. Emerg Infect Dis. 2007;13(2):236–42.PubMedPubMedCentralCrossRef
8.
Clinical Laboratory Standards Institute 2016. Performance standards for antimicrobial susceptibility testing; 26th informational supplement. Wayne: CLSI document M100-S23 Clinical Laboratory Standards Institute.
9.
McClure JA, Conly JM, Lau V, Elsayed S, Louie T, Hutchins W, et al. Novel multiplex PCR assay for detection of the staphylococcal virulence marker Panton-valentine leukocidin genes and simultaneous discrimination of methicillin-susceptible from -resistant staphylococci. J Clin Microbiol. 2006;44(3):1141–4.PubMedPubMedCentralCrossRef
10.
Yıldız Ö, Çoban AY, Şener AG, Coşkuner SA, Bayramoğlu G, Güdücüoğlu H, et al. Antimicrobial susceptibility and resistance mechanisms of methicillin resistant Staphylococcus aureus isolated from 12 hospitals in Turkey. Ann Clin Microbiol Antimicrob. 2014;13:44.PubMedPubMedCentralCrossRef
11.
Zhang K, McClure JA, Conly JM. Enhanced multiplex PCR assay for typing of staphylococcal cassette chromosome mec types I to V in methicillin-resistant Staphylococcus aureus. Mol Cell Probes. 2012;26(5):218–21.PubMedCrossRef
12.
Enright MC, Day NP, Davies CE, Peacock SJ, Spratt BG. Multilocus sequence typing for characterization of methicillin-resistant and methicillin-susceptible clones of Staphylococcus aureus. J Clin Microbiol. 2000;38(3):1008–15.PubMedPubMedCentral
13.
Harmsen D, Claus H, Witte W, Rothgänger J, Claus H, Turnwald D, et al. Typing of methicillin-resistant Staphylococcus aureus in a university hospital setting by using novel software for spa repeat determination and database management. J Clin Microbiol. 2003;41(12):5442–8.PubMedPubMedCentralCrossRef
14.
Marchisio P, Nazzari E, Torretta S, Esposito S, Principi N. Medical prevention of recurrent acute otitis media: an updated overview. Expert Rev Anti-Infect Ther. 2014;12(5):611–20.PubMedCrossRef
15.
Sierra A, Lopez P, Zapata MA, Vanegas B, Castrejon MM, Deantonio R, et al. Non-typeable Haemophilus influenzae and Streptococcus pneumoniae as primary causes of acute otitis media in colombian children: a prospective study. BMC Infect Dis. 2011;11:4.PubMedPubMedCentralCrossRef
16.
Leibovitz E, Jacobs MR, Dagan R. Haemophilus influenzae: a significant pathogen in acute otitis media. Pediatr Infect Dis J. 2004;23:1142–52.PubMed
17.
Al-Mazrou KA, Shibl AM, Kandeil W, Pirçon JY, Marano C. A prospective, observational, epidemiological evaluation of the aetiology and antimicrobial susceptibility of acute otitis media in Saudi children younger than 5years of age. J Epidemiol Glob Health. 2014 Sep;4(3):231–8.PubMedCrossRefPubMedCentral
18.
Changchien CH, Chen YY, Chen SW, Chen WL, Tsay JG, Chu C. Retrospective study of necrotizing fasciitis and characterization of its associated methicillin-resistant Staphylococcus aureus in Taiwan. BMC Infect Dis. 2011;11:297.PubMedPubMedCentralCrossRef
19.
Rodriguez M, Hogan PG, Burnham CA, Fritz SA. Molecular epidemiology of Staphylococcus aureus in households of children with community-associated S aureus skin and soft tissue infections. J Pediatr. 2014 Jan;164(1):105–11.PubMedCrossRef
20.
Gul HC, Kilic A, Guclu AU, Bedir O, Orhon M, Basustaoglu AC. Macrolide-lincosamide-streptogramin B resistant phenotypes and genotypes for methicillin-resistant Staphylococcus aureus in Turkey, from 2003 to 2006. Pol J Microbiol. 2008;57(4):307–12.PubMed
21.
Qiao Y, Ning X, Chen Q, Zhao R, Song W, Zheng Y, et al. Clinical and molecular characteristics of invasive community-acquired Staphylococcus aureus infections in Chinese children. BMC Infect Dis. 2014;14:582.PubMedPubMedCentralCrossRef
22.
Defres S, Marwick C, Nathwani D. MRSA as a cause of lung infection including airway infection, community-acquired pneumonia and hospital-acquired pneumonia. Eur Respir J. 2009;34(6):1470–6.PubMedCrossRef
23.
Kim SH, Kim MG, Kim SS, Cha SH, Yeo SG. Change in detection rate of methicillin-resistant Staphylococcus aureus and Pseudomonas aeruginosa and their antibiotic sensitivities in patients with chronic Suppurative otitis media. J Int Adv Otol. 2015;11(2):151–6.PubMedCrossRef
24.
Rath S, Das SR, Padhy RN. Surveillance of bacteria Pseudomonas aeruginosa and MRSA associated with chronic suppurative otitis media. Braz J Otorhinolaryngol. 2017;83(2):201–6.PubMedCrossRef
25.
Geng W, Yang Y, Wang C, Deng L, Zheng Y, Shen X. Skin and soft tissue infections caused by community-associated methicillin-resistant staphylococcus aureus among children in China. Acta Paediatr. 2010 Apr;99(4):575–80.PubMedCrossRef
26.
Geng W, Yang Y, Wu D, Huang G, Wang C, Deng L, et al. Molecular characteristics of community-acquired, methicillin-resistant Staphylococcus aureus isolated from Chinese children. FEMS Immunol Med Microbiol. 2010;58(3):356–62.PubMedCrossRef
27.
Zhang W, Shen X, Zhang H, Wang C, Deng Q, Liu L, et al. Molecular epidemiological analysis of methicillin-resistant Staphylococcus aureus isolates from Chinese pediatric patients. Eur J Clin Microbiol Infect Dis. 2009;28(7):861–4.PubMedCrossRef
28.
Geng W, Yang Y, Wu D, Zhang W, Wang C, Shang Y, et al. Community-acquired, methicillin-resistant Staphylococcus aureus isolated from children with community-onset pneumonia in China. Pediatr Pulmonol. 2010;45(4):387–94.PubMed
29.
Wang CC, Lo WT, Chu ML, Siu LK. Epidemiological typing of community-acquired methicillin-resistant Staphylococcus aureus isolates from children in Taiwan. Clin Infect Dis. 2004;39(4):481–7.PubMedCrossRef
30.
Song Z, Gu FF, Guo XK, Ni YX, He P, Han LZ. Antimicrobial resistance and molecular characterization of Staphylococcus aureus causing childhood pneumonia in Shanghai. Front Microbiol. 2017;8:455.PubMedPubMedCentral
31.
Liu Y, Wang H, Du N, Shen E, Chen H, Niu J, et al. Molecular evidence for spread of two major methicillin-resistant Staphylococcus aureus clones with a unique geographic distribution in Chinese hospitals. Antimicrob Agents Chemother. 2009;53(2):512–8.PubMedCrossRef
32.
Ho PL, Chuang SK, Choi YF, Lee RA, Lit AC, Ng TK, et al. Hong Kong CA-MRSA surveillance network. Community-associated methicillin-resistant and methicillin-sensitive Staphylococcus aureus: skin and soft tissue infections in Hong Kong. Diagn Microbiol Infect Dis. 2008;61(3):245–50.PubMedCrossRef
33.
Vu BN, Jafari AJ, Aardema M, Tran HK, Nguyen DN, Dao TT, et al. Population structure of colonizing and invasive Staphylococcus aureus strains in northern Vietnam. J Med Microbiol. 2016;65(4):298–305.CrossRef
34.
Song JH, Hsueh PR, Chung DR, Ko KS, Kang CI, Peck KR, et al. ANSORP study group. Spread of methicillin-resistant Staphylococcus aureus between the community and the hospitals in Asian countries: an ANSORP study. J Antimicrob Chemother. 2011;66(5):1061–9.PubMedCrossRef
35.
Ho PL, Chow KH, Lo PY, Lee KF, Lai EL. Changes in the epidemiology of methicillin-resistant Staphylococcus aureus associated with spread of the ST45 lineage in Hong Kong. Diagn Microbiol Infect Dis. 2009;64(2):131–7.PubMedCrossRef
36.
Witte W. Antibiotic resistance in gram-positive bacteria: epidemiological aspects. J Antimicrob Chemother. 1999;44:1–9.PubMedCrossRef
37.
Wang L, Liu Y, Yang Y, Huang G, Wang C, Deng L, et al. Multidrug-resistant clones of community-associated meticillin-resistant Staphylococcus aureus isolated from Chinese children and the resistance genes to clindamycin and mupirocin. J Med Microbiol. 2012;61(9):1240–7.PubMedCrossRef
38.
Reynaga E, Navarro M, Vilamala A, Roure P, Quintana M, Garcia-Nuñez M, et al. Prevalence of colonization by methicillin-resistant Staphylococcus aureus ST398 in pigs and pig farm workers in an area of Catalonia Spain. BMC Infect Dis. 2016;16(1):716.PubMedPubMedCentralCrossRef
39.
Feingold BJ, Silbergeld EK, Curriero FC, van Cleef BA, Heck ME, Kluytmans JA. Livestock density as risk factor for livestock-associated methicillin-resistant Staphylococcus aureus, the Netherlands. Emerg Infect Dis. 2012;18(11):1841–9.PubMedPubMedCentralCrossRef
40.
41.
Ye X, Fan Y, Wang X, Liu W, Yu H, Zhou J, et al. Livestock-associated methicillin and multidrug resistant S. aureus in humans is associated with occupational pig contact, not pet contact. Sci Rep. 2016;6:19184.PubMedPubMedCentralCrossRef
42.
Kuehnert MJ, Kruszon-Moran D, Hill HA, McQuillan G, McAllister SK, Fosheim G, et al. Prevalence of Staphylococcus aureus nasal colonization in the United States, 2001-2002. J Infect Dis. 2006;193(2):172–9.PubMedCrossRef
43.
Li M, Dai Y, Zhu Y, Fu CL, Tan VY, Wang Y, et al. Virulence determinants associated with the Asian community-associated methicillin-resistant Staphylococcus aureus lineage ST59. Sci Rep. 2016;6:27899.PubMedPubMedCentralCrossRef
44.
Li J, Wang L, Ip M, Sun M, Sun J, Huang G, et al. Molecular and clinical characteristics of clonal complex 59 methicillin-resistant Staphylococcus aureus infections in mainland China. PLoS One. 2013;8(8):e70602.PubMedPubMedCentralCrossRef
Metadata
Title
Molecular characterization and antimicrobial susceptibility of Staphylococcus aureus isolated from children with acute otitis media in Liuzhou, China
Authors
Yan Ling Ding
Jinjian Fu
Jichang Chen
Sheng Fu Mo
Shaolin Xu
Nan Lin
Peixu Qin
Eric McGrath
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Pediatrics / Issue 1/2018
Electronic ISSN: 1471-2431
DOI
https://doi.org/10.1186/s12887-018-1366-6

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