Staphylococcal Enterotoxin P Predicts Bacteremia in Hospitalized Patients Colonized With Methicillin-Resistant Staphylococcus aureus
Staphylococcal Enterotoxin P Predicts Bacteremia in Hospitalized Patients Colonized With Methicillin-Resistant Staphylococcus aureus
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DOI：
10.1093/infdis/jit501
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发表时间：
2014-02-15
影响因子：
6.4
通讯作者：
Huang, Susan S.
中科院分区：
文献类型：
--
作者：
Calderwood, Michael S.;Desjardins, Christopher A.;Huang, Susan S.
背景。耐甲氧西林金黄色葡萄球菌（MRSA）定植预测后来的感染，与宿主和病原体侵袭性疾病的决定因素。本巢式病例对照研究评估了2003年9月1日至2005年4月30日期间8个重症监护病房（ICU）前瞻性成人队列中MRSA菌血症的预测因素，积极监测并收集了ICU、ICU后和再入院的MRSA分离株。我们选择了MRSA携带者（病例）和未感染者（对照组）发生MRSA菌血症的病例。生成组装的基因组序列，我们评估了30个MRSA基因可能与毒力和侵袭相关。采用多变量Cox比例风险回归，在控制宿主危险因素的情况下，我们评估了这些基因与MRSA菌血症的关系。我们从520例患者中收集了1578株MRSA。我们分析了33例病例和121例对照者的宿主和病原体因素。MRSA菌血症的预测因素包括癌症诊断、中心静脉导管的存在、高血糖（血糖水平，>200 mg/dL）和携带葡萄球菌肠毒素P （sep）基因的MRSA菌株感染。接受抗mrsa药物治疗具有显著的保护作用。在控制宿主因素的分析中，携带sep的MRSA定殖增加了MRSA菌血症的风险。鉴定危险调节的毒力遗传决定因素可能有助于提高对侵袭性疾病的预测，并提出新的治疗干预目标。
Background. Methicillin-resistant Staphylococcus aureus (MRSA) colonization predicts later infection, with both host and pathogen determinants of invasive disease.Methods. This nested case-control study evaluates predictors of MRSA bacteremia in an 8-intensive care unit (ICU) prospective adult cohort from 1 September 2003 through 30 April 2005 with active MRSA surveillance and collection of ICU, post-ICU, and readmission MRSA isolates. We selected MRSA carriers who did (cases) and those who did not (controls) develop MRSA bacteremia. Generating assembled genome sequences, we evaluated 30 MRSA genes potentially associated with virulence and invasion. Using multivariable Cox proportional hazards regression, we assessed the association of these genes with MRSA bacteremia, controlling for host risk factors.Results. We collected 1578 MRSA isolates from 520 patients. We analyzed host and pathogen factors for 33 cases and 121 controls. Predictors of MRSA bacteremia included a diagnosis of cancer, presence of a central venous catheter, hyperglycemia (glucose level, >200 mg/dL), and infection with a MRSA strain carrying the gene for staphylococcal enterotoxin P (sep). Receipt of an anti-MRSA medication had a significant protective effect.Conclusions. In an analysis controlling for host factors, colonization with MRSA carrying sep increased the risk of MRSA bacteremia. Identification of risk-adjusted genetic determinants of virulence may help to improve prediction of invasive disease and suggest new targets for therapeutic intervention.