Distribution of Staphylococcal cassette chromosome mec Types and correlation with comorbidity and infection type in patients with MRSA bacteremia.
Distribution of Staphylococcal cassette chromosome mec Types and correlation with comorbidity and infection type in patients with MRSA bacteremia.
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DOI：
10.1371/journal.pone.0009489
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发表时间：
2010-03-05
期刊：
影响因子：
3.7
通讯作者：
Chang SC
中科院分区：
文献类型：
--
作者：
Wang JL;Wang JT;Chen SY;Chen YC;Chang SC
基于葡萄球菌盒式染色体mec（SCCmec）分型和耐甲氧西林金黄色葡萄球菌（MRSA）分离株的系统发育分析的分子流行病学定义被认为是区分医疗保健相关MRSA（HA-MRSA）和社区相关MRSA（CA-MRSA）的可靠方法。然而，关于携带不同SCCmec类型的MRSA的菌血症患者的临床特征和结局的信息很少。从2006年1月1日至12月31日，我们记录了159例连续的成人MRSA菌血症患者的人口统计学数据和结果，从这些患者中收集分离株进行SCCmec分析。所有参与者都是台湾三级护理中心的患者。在MRSA分离株中鉴定出以下SCCmec类型：30株SCCmec II（18.9%）、87株SCCmec III（54.7%）、22株SCCmec IV（13.8%）和20株SCCmec V（12.6%）。感染SCCmec III成分分离株的患者从入院到首次MRSA阳性血培养的时间（平均/中位数，50.7/26天）显著长于感染SCCmec IV或V分离株的患者（平均/中位数，SCCmec IV为6.7/3天; SCCmec V为11.1/10.5天）（P<0.05）。在单变量分析中，社区发病、软组织感染和深部感染是SCCmec IV/V的预测因子。在多变量分析中，索引培养前住院时间、糖尿病和卧床不起是与SCCmec II/III相关的独立危险因素。这些发现与先前对CA-MRSA遗传特征的研究一致。MRSA菌血症与SCCmec II/III分离株发生在严重合并症和住院时间延长的患者中。社区发病、皮肤和软组织感染以及深部感染最能预测SCCmec IV/V MRSA菌血症。
Molecular epidemiological definitions that are based on staphylococcal cassette chromosome mec (SCCmec) typing and phylogenetic analysis of methicillin-resistant Staphylococcus aureus (MRSA) isolates are considered a reliable way to distinguish between healthcare-associated MRSA (HA-MRSA) and community-associated MRSA (CA-MRSA). However, there is little information regarding the clinical features and outcomes of bacteremia patients with MRSA carrying different SCCmec types. From January 1 through December 31, 2006, we recorded the demographic data and outcomes of 159 consecutive adult MRSA bacteremia patients from whom isolates for SCCmec analysis were collected. All participants were patients at a tertiary care center in Taiwan. The following SCCmec types were identified in MRSA isolates: 30 SCCmec II (18.9%), 87 SCCmec III (54.7%), 22 SCCmec IV (13.8%), and 20 SCCmec V (12.6%). The time from admission to the first MRSA-positive blood culture for patients infected with isolates with the SCCmec III element (mean/median, 50.7/26 days) was significantly longer than for patients infected with isolates carrying SCCmec IV or V (mean/median, 6.7/3 days for SCCmec IV; 11.1/10.5 days for SCCmec V) (P<0.05). In univariate analysis, community onset, soft tissue infection, and deep-seated infection were predictors for SCCmec IV/V. In multivariate analysis, length of stay before index culture, diabetes mellitus, and being bedridden were independent risk factors associated with SCCmec II/III. These findings are in agreement with previous studies of the genetic characteristics of CA-MRSA. MRSA bacteremia with SCCmec II/III isolates occurred more among patients with serious comorbidities and prolonged hospitalization. Community onset, skin and soft tissue infection, and deep-seated infection best predicted SCCmec IV/V MRSA bacteremia.
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