Outbreak in Alberta of community-acquired (USA300) methicillin-resistant Staphylococcus aureus in people with a history of drug use, homelessness or incarceration
Outbreak in Alberta of community-acquired (USA300) methicillin-resistant Staphylococcus aureus in people with a history of drug use, homelessness or incarceration
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DOI：
10.1503/cmaj.051565
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发表时间：
2006-07-18
影响因子：
14.6
通讯作者：
Conly, John
中科院分区：
文献类型：
--
作者：
Gilbert, Mark;MacDonald, Judy;Conly, John
背景：社区获得性耐甲氧西林金黄色葡萄球菌(CA-MRSA)USA300株可引起严重感染，并日益被认为是社区暴发的原因。2004年，在卡尔加里卫生区(CHR)发现了一次暴发疫情。方法：在中心区域实验室用标准方法鉴定MRSA分离株，并通过脉冲场凝胶电泳法(PFGE)进行分型。用聚合酶链式反应检测mecA、Panton-瓦伦丁杀白素(PVL)、鳞状细胞癌mec和spA基因。如果在2004年1月1日至9月30日期间发现了USA300菌株的临床分离株，并且患者在症状出现前两年内曾在CHR居住或旅行，则病例被定义为此类病例。从几个来源收集了所有此类病例的人口统计、临床和风险数据，以进行统计分析。如果患者有吸毒史、无家可归史或监禁史，则将其定义为高危病例。结果：在40株USA300 PFGE模式的分离株中，PVL、SCC mec Iva和SpA 008型均为阳性。几乎所有感染(39/40，98%)都涉及皮肤和软组织，除了1例死于坏死性出血性肺炎；相当大的比例(38%)需要住院或静脉抗菌治疗。暴发集中在慢性阻塞性肺疾病的高危人群(70%；风险比169.4，95%可信区间86.1-333.0)。这种毒株的出现和传播对加拿大的治疗和公共卫生具有重要影响。
Background: The USA300 strain of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) can cause severe infection and is increasingly recognized as a cause of community outbreaks. In 2004, an outbreak was identified in the Calgary Health Region (CHR).Methods: MRSA isolates were identified with standard methods at a central regional laboratory and typed via pulsed-field gel electrophoresis (PFGE). Isolates were tested by PCR for mecA, Panton-Valentine leukocidin (PVL), SCC mec, and spa genes. Cases were defined as such if a clinical isolate of the USA300 strain was noted between January 1 and September 30, 2004, and the patient had lived or traveled in CHR within 2 years before symptom onset. Demographic, clinical and risk data on all such cases were collected from several sources for statistical analysis. A case was defined as high-risk if the patient had a history of drug use, homelessness or incarceration.Results: Of 40 isolates with the USA300 PFGE pattern, all tested positive for PVL, SCC mec type IVa and spa type 008. Almost all infections (39/40, 98%) involved skin and soft tissues, except for 1 death from necrotizing hemorrhagic pneumonia; a notable proportion (38%) required hospital admission or intravenous antimicrobial therapy. The outbreak centred on the high-risk population in CHR (70%; risk ratio 169.4, 95% confidence interval 86.1 - 333.0).Interpretation: People with histories of illicit drug use, homelessness or recent incarceration were at highest risk for infection with CA-MRSA. The emergence and spread of this virulent strain has important implications for treatment and public health in Canada.