Replacement of HA-MRSA by CA-MRSA infections at an academic medical center in the midwestern United States, 2004-5 to 2008.
Replacement of HA-MRSA by CA-MRSA infections at an academic medical center in the midwestern United States, 2004-5 to 2008.
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DOI：
10.1371/journal.pone.0092760
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发表时间：
2014
期刊：
影响因子：
3.7
通讯作者：
Daum RS
中科院分区：
文献类型：
--
作者：
David MZ;Cadilla A;Boyle-Vavra S;Daum RS
我们注意到，2004 年之后，根据流行病学标准指定为医疗保健相关 (HA-) MRSA 的感染在芝加哥大学医学中心 (UCMC) 的发病率似乎有所下降。我们将 2004 年 5 月 (n = 545) 与 2008 年在 UCMC 任何临床护理地点见到的 MRSA 患者以及引起其感染的分离株进行了比较 (n = 135)。入院后 2 天以上培养的 MRSA 感染患者百分比从 2004 年 5 月的 19.5% 下降到 2008 年的 7.4%（p = 0.001）。与 2008 年相比，2004-5 年上一年住院（49.1% 至 26.7%，p = 0.001）或手术（43.0% 至 14.1%，p<0.001）的百分比有所下降。 2008 年，急诊科就诊的患者比例较高（23.1% vs. 39.3%），重症监护病房（15.6% vs. 6.7%）和其他住院病房（40.7% vs. 32.6%）的患者比例较小（p<0.001）。根据 CDC 流行病学标准，CA-MRSA 感染患者的百分比从 2004 年 5 月的 36.5% 增加到 2008 年的 62.2%（p<0.001）。具有 USA100 遗传特征的 MRSA 分离株百分比从 27.9% (152/545) 下降到 12.6% (17/135)，而具有 CA-MRSA (USA300) 特征的百分比从 53.2% (290/545) 增加到 66.7% (90/135)。侵袭性感染的百分比没有显着变化。我们的数据表明，根据流行病学和微生物学标准，相对于 CA-MRSA，UCMC 的 HA-MRSA 感染在 2004 年 5 月至 2008 年期间有所下降。
We noted anecdotally that infections designated as health care-associated (HA-) MRSA by epidemiologic criteria seemed to be decreasing in incidence at the University of Chicago Medical Center (UCMC) after 2004. We compared MRSA patients seen at any site of clinical care at UCMC and the isolates that caused their infections in 2004-5 (n = 545) with those in 2008 (n = 135). The percent of patients with MRSA infections cultured > 2 days after hospital admission decreased from 19.5% in 2004-5 to 7.4% in 2008 (p = 0.001). The percent in 2004-5 compared with 2008 who had a hospitalization (49.1% to 26.7%, p = 0.001) or surgery (43.0% to 14.1%, p<0.001) in the previous year decreased. In 2008 a greater percent of patients was seen in the emergency department (23.1% vs. 39.3%) and a smaller percent both in intensive care units (15.6% vs. 6.7%) and in other inpatient units (40.7% vs. 32.6%) (p<0.001). The percent of patients with CA-MRSA infections by the CDC epidemiologic criteria increased from 36.5% in 2004-5 to 62.2% in 2008 (p<0.001). The percent of MRSA isolates sharing genetic characteristics of USA100 decreased from 27.9% (152/545) to 12.6% (17/135), while the percent with CA-MRSA (USA300) characteristics increased from 53.2% (290/545) to 66.7% (90/135). The percent of infections that were invasive did not change significantly. Our data suggest that HA-MRSA infections, both by epidemiologic and microbiologic criteria, relative to CA-MRSA, decreased between 2004-5 and 2008 at UCMC.
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