Epidemiology and outcome of pneumonia caused by methicillin-resistant Staphylococcus aureus (MRSA) in Canadian hospitals.
Epidemiology and outcome of pneumonia caused by methicillin-resistant Staphylococcus aureus (MRSA) in Canadian hospitals.
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DOI：
10.1371/journal.pone.0075171
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发表时间：
2013
期刊：
影响因子：
3.7
通讯作者：
Simor AE
中科院分区：
文献类型：
--
作者：
Tadros M;Williams V;Coleman BL;McGeer AJ;Haider S;Lee C;Iacovides H;Rubinstein E;John M;Johnston L;McNeil S;Katz K;Laffin N;Suh KN;Powis J;Smith S;Taylor G;Watt C;Simor AE
MRSA仍然是医院获得性（HAP）和医疗保健相关性肺炎（HCAP）的主要原因。我们描述了MRSA肺炎在加拿大医院的流行病学和结果，并确定了导致死亡率的因素。在11家加拿大医院对成人MRSA肺炎进行了为期一年（2011年）的前瞻性监测。MRSA HAP、HCAP、呼吸机相关性肺炎（VAP）和社区获得性肺炎（CAP）的标准标准用于识别病例。MRSA分离株进行了抗菌药物敏感性试验，并通过脉冲场凝胶电泳（PFGE）和Panton-Valentine杀白细胞素（PVL）基因检测进行了表征。主要结局是30天时的全因死亡率。进行多变量分析以检查各种宿主和微生物因素与死亡率之间的关联。共确定了161例MRSA肺炎患者：90例（56%）HAP，26例（16%）HCAP和45例（28%）CAP; 23例（14%）VAP患者。MRSA HAP的平均（± SD）发生率为0.32（± 0.26）/10,000患者-日，MRSA VAP的平均（± SD）发生率为0.30（± 0.5）/1,000呼吸机-日。30天全因死亡率为28.0%。在多变量分析中，与死亡率相关的变量为多器官衰竭（OR 8.1; 95% CI 2.5-26.0）和万古霉素敏感性降低的分离株感染（OR 2.5，95% CI 1.0-6.3）。MRSA肺炎与显著的死亡率相关。疾病的严重程度和由对万古霉素MIC升高的分离株引起的感染与死亡率增加相关。需要进行更多的研究，以更好地了解宿主和微生物变量对结果的影响。
MRSA remains a leading cause of hospital-acquired (HAP) and healthcare-associated pneumonia (HCAP). We describe the epidemiology and outcome of MRSA pneumonia in Canadian hospitals, and identify factors contributing to mortality. Prospective surveillance for MRSA pneumonia in adults was done for one year (2011) in 11 Canadian hospitals. Standard criteria for MRSA HAP, HCAP, ventilator-associated pneumonia (VAP), and community-acquired pneumonia (CAP) were used to identify cases. MRSA isolates underwent antimicrobial susceptibility testing, and were characterized by pulsed-field gel electrophoresis (PFGE) and Panton-Valentine leukocidin (PVL) gene detection. The primary outcome was all-cause mortality at 30 days. A multivariable analysis was done to examine the association between various host and microbial factors and mortality. A total of 161 patients with MRSA pneumonia were identified: 90 (56%) with HAP, 26 (16%) HCAP, and 45 (28%) CAP; 23 (14%) patients had VAP. The mean (± SD) incidence of MRSA HAP was 0.32 (± 0.26) per 10,000 patient-days, and of MRSA VAP was 0.30 (± 0.5) per 1,000 ventilator-days. The 30-day all-cause mortality was 28.0%. In multivariable analysis, variables associated with mortality were the presence of multiorgan failure (OR 8.1; 95% CI 2.5-26.0), and infection with an isolate with reduced susceptibility to vancomycin (OR 2.5, 95% CI 1.0-6.3). MRSA pneumonia is associated with significant mortality. Severity of disease at presentation, and infection caused by an isolate with elevated MIC to vancomcyin are associated with increased mortality. Additional studies are required to better understand the impact of host and microbial variables on outcome.
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