The Changing Epidemiology of Methicillin-Resistant Staphylococcus aureus in the United States: A National Observational Study
The Changing Epidemiology of Methicillin-Resistant Staphylococcus aureus in the United States: A National Observational Study
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DOI：
10.1093/aje/kws273
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发表时间：
2013-04-01
影响因子：
5
通讯作者：
Laxminarayan, Ramanan
中科院分区：
文献类型：
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作者：
Klein, Eili Y.;Sun, Lova;Laxminarayan, Ramanan
耐甲氧西林金黄色葡萄球菌 (MRSA) 可导致重大疾病和死亡，给患者和医院带来严重的经济成本。社区相关 MRSA (CA-MRSA) 是美国医院中一个日益严重的问题，美国医院已经在处理高水平的医院相关 MRSA (HA-MRSA)，但人们对患者年龄和这两种形式 MRSA 发病率的季节差异如何影响流行病知之甚少。通过使用有关住院和抗生素耐药性的国家数据，我们根据患者年龄、感染类型和耐药表型（CA-MRSA 与 HA-MRSA）估计了 2005-2009 年每年金黄色葡萄球菌和 MRSA 住院率的大小和趋势。尽管在研究期间住院率没有出现统计上显着的增加，但感染总数有所增加。 2009 年，估计有 463,017 例（95% 置信区间：441,595、484,439）MRSA 相关住院患者，每 1,000 例住院患者中有 11.74 例（95% 置信区间：11.20、12.28）。我们观察到不同年龄的感染类型存在显着差异，HA-MRSA 相关的住院治疗在老年人中更为常见。我们还注意到发病率具有显着的季节性，特别是在儿童中，CA-MRSA 在夏末达到峰值，HA-MRSA 在冬季达到峰值，这可能是由抗生素处方模式的季节性变化引起的。
Methicillin-resistant Staphylococcus aureus (MRSA) can cause major illness and death and impose serious economic costs on patients and hospitals. Community-associated MRSA (CA-MRSA) is a growing problem in US hospitals, which are already dealing with high levels of hospital-associated MRSA (HA-MRSA), but little is known about how patient age and seasonal differences in the incidence of these 2 forms of MRSA affect the epidemic. By using national data on hospitalizations and antibiotic resistance, we estimated the magnitude and trends in annual S. aureus and MRSA hospitalization rates from 2005-2009 by patient age, infection type, and resistance phenotype (CA-MRSA vs. HA-MRSA). Although no statistically significant increase in the hospitalization rate was seen over the study period, the total number of infections increased. In 2009, there were an estimated 463,017 (95% confidence interval: 441,595, 484,439) MRSA-related hospitalizations at a rate of 11.74 (95% confidence interval: 11.20, 12.28) per 1,000 hospitalizations. We observed significant differences in infection type by age, with HA-MRSA related hospitalizations being more common in older individuals. We also noted significant seasonality in incidence, particularly in children, with CA-MRSA peaking in the late summer and HA-MRSA peaking in the winter, which may be caused by seasonal shifts in antibiotic prescribing patterns.