Concurrent Epidemics of Skin and Soft Tissue Infection and Bloodstream Infection Due to Community-Associated Methicillin-Resistant Staphylococcus aureus
Concurrent Epidemics of Skin and Soft Tissue Infection and Bloodstream Infection Due to Community-Associated Methicillin-Resistant Staphylococcus aureus
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DOI：
10.1093/cid/cis527
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发表时间：
2012-09-15
影响因子：
11.8
通讯作者：
Binh An Diep
中科院分区：
文献类型：
--
作者：
Tattevin, Pierre;Schwartz, Brian S.;Binh An Diep
背景自2000年出现以来，耐甲氧西林金黄色葡萄球菌（MRSA）克隆USA 300的流行性传播已导致美国皮肤和软组织感染（SSTI）的高负担，但其对MRSA血流感染（BSI）的影响尚不清楚。为了评估在流行期间引起SSTI和BSI的MRSA分离株的克隆性，从2000年至2008年在旧金山弗朗西斯科回收的1350株独特感染分离株（共7252株）中分层随机样本进行基因分型。回顾性分析了549例由USA 300流行性克隆和非USA 300 MRSA克隆引起的BSI病例的危险因素和结局。从2000年到2008年，USA 300 SSTI和USA 300 BSI的长期趋势具有很强的相关性（Pearson r = 0.953）。USA 300占BSI的55%（304/549），因为它是导致社区相关（115/160）、医疗保健相关社区发作（125/207）和医院发作（64/182）BSI的主要MRSA克隆。USA 300和非USA 300的BSI诊断后住院时间和死亡率相似。确定了USA 300 BSI的两个独立风险因素：并发SSTI（调整的相对风险，1.4 [95%置信区间{CI}，1.2-1.6]）和前30天内使用抗MRSA抗菌剂（0.7 [95% CI，.6-.8]）。并发SSTI的分离株与引起BSI的USA 300分离株在基因型上无法区分。USA 300 SSTI作为BSI的来源。控制USA 300 SSTI流行的策略可能会减轻并发USA 300 BSI流行的严重程度。
Background. Since its emergence in 2000, epidemic spread of the methicillin-resistant Staphylococcus aureus (MRSA) clone USA300 has led to a high burden of skin and soft tissue infections (SSTIs) in the United States, yet its impact on MRSA bloodstream infections (BSIs) is poorly characterized.Methods. To assess clonality of the MRSA isolates causing SSTI and BSI during the epidemic period, a stratified, random sample of 1350 unique infection isolates (from a total of 7252) recovered at the Community Health Network of San Francisco from 2000 to 2008 were selected for genotyping. Risk factors and outcomes for 549 BSI cases caused by the USA300 epidemic clone and non-USA300 MRSA clones were assessed by retrospective review of patient medical records.Results. From 2000 to 2008, secular trends of USA300 SSTI and USA300 BSI were strongly correlated (Pearson r = 0.953). USA300 accounted for 55% (304/549) of BSIs as it was the predominant MRSA clone that caused community-associated (115/160), healthcare-associated community-onset (125/207), and hospital-onset (64/182) BSIs. Length of hospitalization after BSI diagnosis and mortality rates for USA300 and non-USA300 were similar. Two independent risk factors for USA300 BSI were identified: concurrent SSTI (adjusted relative risk, 1.4 [95% confidence interval {CI}, 1.2-1.6]) and anti-MRSA antimicrobial use in the preceding 30 days (0.7 [95% CI, .6-.8]). Isolates from concurrent SSTI were indistinguishable genotypically from the USA300 isolates that caused BSI.Conclusions. USA300 SSTIs serve as a source for BSI. Strategies to control the USA300 SSTI epidemic may lessen the severity of the concurrent USA300 BSI epidemic.