Epidemiologic Similarities in Pediatric Community-Associated Methicillin-Resistant and Methicillin-Sensitive Staphylococcus aureus in the San Francisco Bay Area
Epidemiologic Similarities in Pediatric Community-Associated Methicillin-Resistant and Methicillin-Sensitive Staphylococcus aureus in the San Francisco Bay Area
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DOI：
10.1093/jpids/pis061
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发表时间：
2012-09-01
影响因子：
3.2
通讯作者：
Pan, Erica
中科院分区：
文献类型：
--
作者：
Hsiang, Michelle S.;Shiau, Rita;Pan, Erica
背景在儿科社区区分耐甲氧西林金黄色葡萄球菌（MRSA）和甲氧西林敏感金黄色葡萄球菌（MSSA）感染的危险因素尚不清楚。我们对旧金山弗朗西斯科湾区儿童社区相关（CA）MRSA和MSSA病例的临床、流行病学和分子因素进行了前瞻性病例比较研究。在270例CA-MRSA和313例CA-MSSA病例中进行了图表审查。58例CAMRSA（21.4%）和95例CA-MSSA（30.4%）进行了访谈。对111株分离株进行分子分型。MSSA占CA病例的53.7%，更可能导致浸润性疾病（6.2% vs 1.1%，P = 0.004）。几乎没有潜在的流行病学风险因素区分CA-MRSA和CA-MSSA。在与拥挤、清洁度或先前使用抗生素相关的因素中没有发现差异。湿疹导致的皮肤完整性受损（24.3% vs 13.5%，P = 0.001）与CAMSSA相关。许多暴露于潜在感染或殖民接触或污染的物体进行了评估;只有三个与CA-MSSA相关：有一个家庭接触谁在过去一年中做过手术（18.9%比6.0%，P = .02），并定期访问公共淋浴（9.1%比2.0%，P = .01）或健身房（12.6%比3.3%，P = .04）。分子分型结果显示，CA-MRSA（96.4%）和CA-MSSA（39.3%）的主要遗传谱系为克隆复合物8。在最近高度关注CA-MRSA的背景下，不应忽视CA-MSSA在儿童中引起的严重疾病负担。MRSA和MSSA在流行病学上可能越来越相似;因此，研究、临床和公共卫生工作应将金黄色葡萄球菌作为一个单一实体。
Background. Risk factors differentiating methicillin-resistant Staphylococcus aureus (MRSA) from methicillin-sensitive S aureus (MSSA) infections in the pediatric community have been unclear.Methods. We performed a prospective case-comparison investigation of clinical, epidemiological, and molecular factors in pediatric community-associated (CA) MRSA and MSSA cases in the San Francisco Bay Area. Chart reviews were conducted in 270 CA-MRSA and 313 CA-MSSA cases. Fifty-eight CAMRSA (21.4%) and 95 CA-MSSA (30.4%) cases were interviewed. Molecular typing was performed on 111 isolates.Results. MSSA represented 53.7% of CA cases and was more likely to cause invasive disease (6.2% vs 1.1%, P = .004). Few potential epidemiologic risk factors distinguished CA-MRSA from CA-MSSA. No differences were found in factors related to crowding, cleanliness, or prior antibiotic use. Compromised skin integrity due to eczema (24.3% vs 13.5%, P = .001) was associated with CAMSSA. Many exposures to potentially infected or colonized contacts or contaminated objects were assessed; only three were associated with CA-MSSA: having a household contact who had surgery in the past year (18.9% vs 6.0%, P = .02), and regular visits to a public shower (9.1% vs 2.0%, P = .01) or gym (12.6% vs 3.3%, P = .04). Molecular typing identified clonal complex 8 as the predominant genetic lineage among CA-MRSA (96.4%) and CA-MSSA (39.3%) isolates.Conclusions. In the context of recent heightened focus on CA-MRSA, the burden of serious disease caused by CA-MSSA among children should not be overlooked. MRSA and MSSA may be growing epidemiologically similar; thus, research, clinical, and public health efforts should focus on S aureus as a single entity.