Invasive methicillin-resistant Staphylococcus aureus infections in the United States
Invasive methicillin-resistant Staphylococcus aureus infections in the United States
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DOI：
10.1001/jama.298.15.1763
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发表时间：
2007-10-17
影响因子：
120.7
通讯作者：
Fridkin, Scott K.
中科院分区：
文献类型：
--
作者：
Klevens, R. Monina;Morrison, Melissa A.;Fridkin, Scott K.
背景随着耐甲氧西林金黄色葡萄球菌（MRSA）感染的流行病学的变化，需要关于美国人群MRSA感染的范围和程度的准确信息。目的描述美国9个社区中侵袭性MRSA疾病的发病率和分布，并估计2005年美国侵袭性MRSA感染的负担。从2004年7月到2005年12月，在9个参与活动性细菌核心监测（ABC）/新发感染项目网络的地点进行基于人群的侵袭性MRSA监测。对MRSA的报告进行了调查，并将其归类为与医疗保健相关的（医院发病或社区发病）或社区相关主要结果测量2005年美国MRSA患者中侵袭性MRSA感染和院内死亡的发病率和估计数量;间隔估计的发病率，不包括1个网站，似乎是一个离群值与最高的发病率;感染strain.Results的分子特征有8987例侵袭性MRSA的监测期间报告。大多数MRSA感染与医疗保健相关：5250例（58.4%）为社区感染，2389例（26.6%）为医院感染; 1234例（13.7%）为社区相关感染，114例（1.3%）无法分类。2005年，侵袭性MRSA的标准化发病率为31.8/10万（区间估计值为24.4-35.2）。65岁及以上人群（127.7/100000;区间估计值，92.6-156.9）、黑人（66.5/100000;区间估计值，43.5-63.1）和男性（37.5/100000;区间估计值，26.8-39.5）的发病率最高。在监测期间，MRSA感染患者中有1598例院内死亡。2005年，标准化死亡率为每10万人6.3人（区间估计值为3.3-7.5）。分子检测确定菌株的历史上与社区相关的疾病暴发恢复的文化在医院发病和社区发病的卫生保健相关的感染在所有surveillance.Conclusions侵袭性MRSA感染影响某些人群不成比例。它是一个主要的公共卫生问题，主要与医疗保健有关，但不再局限于重症监护室，急性护理医院或任何医疗保健机构。
Context As the epidemiology of infections with methicillin-resistant Staphylococcus aureus (MRSA) changes, accurate information on the scope and magnitude of MRSA infections in the US population is needed.Objectives To describe the incidence and distribution of invasive MRSA disease in 9 US communities and to estimate the burden of invasive MRSA infections in the United States in 2005.Design and Setting Active, population-based surveillance for invasive MRSA in 9 sites participating in the Active Bacterial Core surveillance (ABCs)/Emerging Infections Program Network from July 2004 through December 2005. Reports of MRSA were investigated and classified as either health care-associated (either hospital-onset or community-onset) or community-associated (patients without established health care risk factors for MRSA).Main Outcome Measures Incidence rates and estimated number of invasive MRSA infections and in-hospital deaths among patients with MRSA in the United States in 2005; interval estimates of incidence excluding 1 site that appeared to be an outlier with the highest incidence; molecular characterization of infecting strains.Results There were 8987 observed cases of invasive MRSA reported during the surveillance period. Most MRSA infections were health care-associated: 5250 (58.4%) were community-onset infections, 2389 (26.6%) were hospital-onset infections; 1234 (13.7%) were community-associated infections, and 114 (1.3%) could not be classified. In 2005, the standardized incidence rate of invasive MRSA was 31.8 per 100 000 (interval estimate, 24.4-35.2). Incidence rates were highest among persons 65 years and older (127.7 per 100 000; interval estimate, 92.6-156.9), blacks (66.5 per 100 000; interval estimate, 43.5-63.1), and males (37.5 per 100000; interval estimate, 26.8-39.5). There were 1598 in-hospital deaths among patients with MRSA infection during the surveillance period. In 2005, the standardized mortality rate was 6.3 per 100 000 (interval estimate, 3.3-7.5). Molecular testing identified strains historically associated with community-associated disease outbreaks recovered from cultures in both hospital-onset and community-onset health care-associated infections in all surveillance areas.Conclusions Invasive MRSA infection affects certain populations disproportionately. It is a major public health problem primarily related to health care but no longer confined to intensive care units, acute care hospitals, or any health care institution.