Vancomycin-resistant staphylococcus aureus in the United States, 2002-2006
Vancomycin-resistant staphylococcus aureus in the United States, 2002-2006
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DOI：
10.1086/527392
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发表时间：
2008-03-01
影响因子：
11.8
通讯作者：
Hageman, Jeffrey C.
中科院分区：
文献类型：
--
作者：
Sievert, Dawn M.;Rudrik, James T.;Hageman, Jeffrey C.
背景资料。本报告比较了2002-2006年间美国所有7例万古霉素耐药金黄色葡萄球菌(VRSA)感染的临床特征、流行病学调查、感染控制评估和微生物学结果。收集了流行病学、临床和感染控制信息。对VRSA分离株进行确证鉴定、药敏试验、脉冲场凝胶电泳法和耐药基因分型。为了评估VRSA的传播，对病例患者及其接触者进行了VRSA携带者筛查。2002年至2006年共发现7例；密歇根州报告了5例，宾夕法尼亚州报告了1例，纽约报告了1例。所有VRSA菌株均为VANA阳性，对万古霉素的最低抑菌浓度中位数为512 mg/mL。所有患者都有甲氧西林耐药金黄色葡萄球菌和肠球菌感染或定植的病史；所有患者都有几种潜在疾病，包括慢性皮肤溃疡；大多数患者在感染VRSA之前接受了万古霉素治疗。除任何病例患者外，未发现VRSA在人与人之间传播。对感染控制预防措施进行了评估，并与已建立的指南一致。在美国，已发现7名VRSA患者呈VANA阳性。微生物实验室的迅速检测和对耐多药微生物建议的感染控制措施的遵守似乎防止了向其他患者传播。
Background. This report compares the clinical characteristics, epidemiologic investigations, infection-control evaluations, and microbiologic findings of all 7 of the cases of vancomycin-resistant Staphylococcus aureus (VRSA) infection in the United States during the period 2002-2006.Methods. Epidemiologic, clinical, and infection-control information was collected. VRSA isolates underwent confirmatory identification, antimicrobial susceptibility testing, pulsed-field gel electrophoresis, and typing of the resistance genes. To assess VRSA transmission, case patients and their contacts were screened for VRSA carriage.Results. Seven cases were identified from 2002 through 2006; 5 were reported from Michigan, 1 was reported from Pennsylvania, and 1 was reported from New York. All VRSA isolates were vanA positive and had a median vancomycin minimum inhibitory concentration of 512 mg/mL. All case patients had a history of prior methicillin-resistant S. aureus and enterococcal infection or colonization; all had several underlying conditions, including chronic skin ulcers; and most had received vancomycin therapy prior to their VRSA infection. Person-to-person transmission of VRSA was not identified beyond any of the case patients. Infection-control precautions were evaluated and were consistent with established guidelines.Conclusions. Seven patients with vanA-positive VRSA have been identified in the United States. Prompt detection by microbiology laboratories and adherence to recommended infection control measures for multidrug-resistant organisms appear to have prevented transmission to other patients.