Trends and Characteristics of Culture-Confirmed Staphylococcus aureus Infections in a Large U.S. Integrated Health Care Organization
Trends and Characteristics of Culture-Confirmed Staphylococcus aureus Infections in a Large U.S. Integrated Health Care Organization
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DOI：
10.1128/jcm.00134-12
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发表时间：
2012-06-01
影响因子：
9.4
通讯作者：
Baxter, Roger
中科院分区：
文献类型：
--
作者：
Ray, G. Thomas;Suaya, Jose A.;Baxter, Roger
在美国，由金黄色葡萄球菌引起的感染是一个严重的健康问题。1990年至2005年间，社区相关的耐甲氧西林金黄色葡萄球菌（MRSA）急剧增加，但最近的报告表明，MRSA可能正在下降。我们回顾性地鉴定了1998年1月1日至2009年12月31日期间从大型综合健康计划患者中获得的金黄色葡萄球菌分离株（n = 133,450）。分析了MRSA随时间的趋势，并确定了MRSA与甲氧西林敏感金黄色葡萄球菌（MSSA）的人口统计学危险因素。金黄色葡萄球菌分离株为MRSA的百分比在1998年至2001年期间从9%增加到20%，在2002年至2005年期间从25%增加到49%，在2006年至2009年期间从49%下降到43%。MRSA的增加在血液和其他细菌标本中可见，发生在所有年龄和种族/民族群体中，尽管在18至50岁以下的人群和非裔美国人中最为明显。院内感染最可能是MRSA（优势比[OR]为1.58；置信区间[CI]为1.46 ~ 1.70，与社区相关病例相比），但MRSA增加最多的是社区相关感染。来自非洲裔美国人（OR, 1.73； CI， 1.64至1.82）和西班牙裔美国人（OR, 1.11； CI， 1.06至1.16）的分离株比来自白人的分离株更可能是MRSA。1998年至2005年期间，金黄色葡萄球菌分离株中MRSA的比例大幅增加，2006年至2009年期间，这一比例下降。医院发病的金黄色葡萄球菌感染是不成比例的MRSA，非洲裔美国人也是如此。
Infections due to Staphylococcus aureus present a significant health problem in the United States. Between 1990 and 2005, there was a dramatic increase in community-associated methicillin-resistant S. aureus (MRSA), but recent reports suggest that MRSA may be declining. We retrospectively identified S. aureus isolates (n = 133,450) that were obtained from patients in a large integrated health plan between 1 January 1998 and 31 December 2009. Trends over time in MRSA were analyzed, and demographic risk factors for MRSA versus methicillin-susceptible S. aureus (MSSA) were identified. The percentage of S. aureus isolates that were MRSA increased from 9% to 20% between 1998 and 2001 and from 25% to 49% between 2002 and 2005 and decreased from 49% to 43% between 2006 and 2009. The increase in MRSA was seen in blood and in other bacteriological specimens and occurred in all age and race/ethnicity groups, though it was most pronounced in persons aged 18 to < 50 years and African-Americans. Hospital onset infections were the most likely to be MRSA (odds ratio [OR], 1.58; confidence interval [CI], 1.46 to 1.70, compared to community-associated cases), but the largest increase in MRSA was in community-associated infections. Isolates from African-Americans (OR, 1.73; CI, 1.64 to 1.82) and Hispanics (OR, 1.11; CI, 1.06 to 1.16) were more likely to be MRSA than those from whites. After substantial increases between 1998 and 2005 in the proportion of S. aureus isolates that were MRSA, the proportion decreased between 2006 and 2009. Hospital onset S. aureus infections are disproportionately MRSA, as are those among African-Americans.