The nosocomial transmission rate of animal-associated ST398 meticillin-resistant Staphylococcus aureus
The nosocomial transmission rate of animal-associated ST398 meticillin-resistant Staphylococcus aureus
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DOI：
10.1098/rsif.2010.0349
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发表时间：
2011-04-01
影响因子：
3.9
通讯作者：
Bonten, Marc J. M.
中科院分区：
文献类型：
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作者：
Bootsma, Martin C. J.;Wassenberg, Marjan W. M.;Bonten, Marc J. M.
耐甲氧西林金黄色葡萄球菌（MRSA）的全球流行病学特征是具有不同流行病学行为的不同克隆谱系。有流行性医院克隆（医院相关（HA-）MRSA），主要引起社区获得性感染的克隆（社区相关（CA-）MRSA，主要是USA300）和在欧洲和美国牲畜中出现的动物相关克隆（ST 398），随后传播给人类。这些不同类型的MRSA的医院传播能力（R-A）从未被量化。使用来自荷兰医院MRSA爆发的两个大型数据集（数据集1，UMC乌得勒支144个月;数据集2，51家医院6个月）和最近开发的数学模型，我们确定了ST 398和非ST 398分离株的基因型特异性R-A（分类为HA-MRSA），使用观察数据、MRSA携带检出率和出院率作为输入。在数据集1中检测到42例MRSA指数病例（均为非ST 398 MRSA）后，筛选了5076人，产生30例继发病例。在数据集2中，75例索引病例（51例非ST 398 MRSA和24例ST 398）分别导致7892例筛选个体和56例和3例非ST 398 MRSA和ST 398继发病例。出院率与检出率之比为2.7。数据集1中非ST 398 MRSA的R-A值（95%置信区间（CI））为0.68（0.47 - 0.95），数据集2中非ST 398 MRSA为0.93（0.71 - 1.21），ST 398为0.16（0.04 - 0.40）。非ST 398 MRSA与ST 398之间的R-A比值为5.90（95% CI 2.24 - 23.81）。在荷兰医院，ST 398的传播性比非ST 398 MRSA低5.9倍，这可能允许对ST 398 MRSA采取不太严格的传播控制措施。
The global epidemiology of meticillin-resistant Staphylococcus aureus (MRSA) is characterized by different clonal lineages with different epidemiological behaviour. There are pandemic hospital clones (hospital-associated (HA-) MRSA), clones mainly causing community-acquired infections (community-associated (CA-) MRSA, mainly USA300) and an animal-associated clone (ST398) emerging in European and American livestock with subsequent spread to humans. Nosocomial transmission capacities (R-A) of these different MRSA types have never been quantified. Using two large datasets from MRSA outbreaks in Dutch hospitals (dataset 1, the UMC Utrecht for 144 months; dataset 2, 51 hospitals for six months) and a recently developed mathematical model, we determined the genotype-specific R-A for ST398 and non-ST398 isolates (categorized as HA-MRSA), using observational data, the detection rate of MRSA carriage and the discharge rate from hospital as the input. After detection of 42 MRSA index cases in dataset 1 (all non-ST398 MRSA) 5076 people were screened, yielding 30 secondary cases. In dataset 2, 75 index cases (51 non-ST398 MRSA and 24 ST398) resulted in 7892 screened individuals and 56 and three secondary cases for non-ST398 MRSA and ST398, respectively. The ratio between discharge and the detection rate was 2.7. R-A values (95% confidence interval (CI)) were 0.68 (0.47-0.95) for non-ST398 MRSA in dataset 1, 0.93 (0.71-1.21) for non-ST398 MRSA in dataset 2 and 0.16 (0.04-0.40) for ST398. The R-A ratio between non-ST398 MRSA and ST398 was 5.90 (95% CI 2.24-23.81). ST398 is 5.9 times less transmissible than non-ST398 MRSA in Dutch hospitals, which may allow less stringent transmission-control measures for ST398 MRSA.