Prevalence and clinical prognosis of heteroresistant vancomycin-intermediate Staphylococcus aureus in a tertiary care center in China.
Prevalence and clinical prognosis of heteroresistant vancomycin-intermediate Staphylococcus aureus in a tertiary care center in China.
复制标题
中国三级医疗中心异耐药万古霉素-中度金黄色葡萄球菌的患病率和临床预后。
DOI：
10.3760/cma.j.issn.0366-6999.20120812
复制
发表时间：
2013
影响因子：
6.1
通讯作者：
T. Sun
中科院分区：
文献类型：
--
作者：
Yan Wang;Yun;Xiao;Hong;T. Sun
背景
耐万古霉素中间体金黄色葡萄球菌(HVISA)的出现对诊断微生物学实验室的检测方法提出了越来越大的挑战。然而，有关hVISA的报道在中国中并不多见。这项研究总结了我们机构与hVISA感染相关的流行率和临床特征，以及它们对临床结果的局部影响。
方法
共收集致病菌耐甲氧西林金黄色葡萄球菌(MRSA)122株。纳入102例患者，我们有完整的耐甲氧西林金黄色葡萄球菌肺炎的信息。用聚合酶链式反应检测MRSA的mecA基因。同时进行ETEST和宏ETEST以筛选hVISA。采用多重聚合酶链式反应方法对葡萄球菌染色体盒(SCCmec)进行分型。对危险因素进行Logistic回归分析。
结果
在收集的122株MRSA中，有25株(20.5%)为hVISA。SCCmecⅢ119株(97.5%)，SCCmec II 2株(1.6%)，SCCmec V 1株(0.8%)。MRSA-医院获得性肺炎(HAP)30d病死率为37.3%，hVISA-HAP为62.5%。万古霉素治疗是hVISA的独立危险因素。在所有患者中，与30天死亡率独立相关的因素是急性生理学和慢性健康评估(APACHE)II评分20、多叶病变和肌酐清除率(Ccr)和15ml/min。
结论
我校HIV-VISA感染率为20.5%。HVISA-HAP患者的临床预后较差。万古霉素治疗是hVISA感染的独立预测因素。在所有患者中，与30天死亡率独立相关的因素是APACHE II评分20分、多叶病变和CCR<；15ml/min。
BACKGROUND
The emergence of heteroresistant vancomycin-intermediate Staphylococcus aureus (hVISA) is increasingly challenging the methods for detection in diagnostic microbiology laboratories. However, the report of hVISA is rare in China. This study summarizes the prevalence and clinical features associated with hVISA infections at our institution and the local impact they have on clinical outcome.
METHODS
A total of 122 methicillin-resistant Staphylococcus aureus (MRSA) isolates which were of the causative pathogens were collected. One hundred and two patients for whom we had full information of MRSA pneumonia were included. Isolates of MRSA were collected using PCR to detect the mecA gene. Both Etest and macro Etest were performed to screen for hVISA. The Staphylococcal chromosome cassette mec (SCCmec) types were determined by multiplex PCR strategy. Logistic regression analysis was used to determine the risk factors.
RESULTS
Among the 122 MRSA isolates collected, 25 (20.5%) strains were identified as hVISA. There were 119 (97.5%) SCCmec III isolates, two (1.6%) SCCmec II isolates, and one (0.8%) SCCmec V isolate. The 30-day mortality of MRSA-hospital acquired pneumonia (HAP) was 37.3%, and 62.5% for hVISA-HAP. Vancomycin treatment was the independent risk factor of hVISA. Factors independently associated with 30-day mortality in all patients were acute physiology and Chronic Health Evaluation (APACHE) II score >20, multiple lobe lesions, and creatinine clearance rate (CCR) < 15 ml/min.
CONCLUSIONS
The prevalence of hVISA is 20.5% at our institution. hVISA-HAP patients had a poor clinical outcome. Vancomycin treatment was the independent predictors for hVISA infection. Factors independently associated with 30-day mortality in all patients were APACHE II score > 20, multiple lobe lesions and CCR < 15 ml/min.