Changing Characteristics of Staphylococcus aureus Bacteremia: Results From a 21-Year, Prospective, Longitudinal Study
Changing Characteristics of Staphylococcus aureus Bacteremia: Results From a 21-Year, Prospective, Longitudinal Study
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DOI：
10.1093/cid/ciz112
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发表时间：
2019-12-01
影响因子：
11.8
通讯作者：
Fowler, Vance G., Jr.
中科院分区：
文献类型：
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作者：
Souli, Maria;Ruffin, Felicia;Fowler, Vance G., Jr.
背景我们进行了一项纵向研究，以评估在临床表现和流行病学的变化，金黄色葡萄球菌菌血症（SAB）的学术，美国医疗中心。从1995年1月至2015年12月入组了患有单一微生物SAB的连续患者。每个人的初始血流S。使用SPA分型对金黄色葡萄球菌分离株进行基因分型。使用Ridom StaphType软件分配克隆复合物（CC）。用线性回归估计患者和细菌特征随时间的变化。基因型或临床特征与并发症之间的关系采用多变量回归模型进行估计。在2348名合格的参与者中，54.2%有某种类型的植入性异物。在21年的研究期间，这一比例显著增加，每年增加0.96%（P = 0.002），合并症和院外获得也是如此。任何转移性并发症的发生率也显著增加，每年增加0.94%（P = 0.019）。在相应的血流S.金黄色葡萄球菌分离株spa-CC 012（多位点序列类型[MLST] CC 30）、-CC 004（MLST CC 45）、-CC 189（MLST CC 1）和-CC 084（MLST CC 15）在研究期间均显著下降，而spa-CC 008（MLST CC 8）显著增加。由于spa-CC 008导致SAB的患者通常更容易发生转移性并发症，特别是脓肿、脓毒性栓塞和持续菌血症。在调整人口统计学、种族和临床变量后，spa-CC 008的USA 300变体与转移性并发症独立相关（优势比1.42; 95%可信区间1.02-1.99）。监测SAB并发症的系统方法和相应的血流分离株的基因分型将有助于识别高毒力克隆的出现，并可能改善这种综合征的临床管理。
Background. We conducted a longitudinal study to evaluate changes in the clinical presentation and epidemiology of Staphylococcus aureus bacteremia (SAB) in an academic, US medical center.Methods. Consecutive patients with monomicrobial SAB were enrolled from January 1995 to December 2015. Each person's initial bloodstream S. aureus isolate was genotyped using spa typing. Clonal complexes (CCs) were assigned using Ridom StaphType software. Changes over time in both the patient and bacterial characteristics were estimated with linear regression. Associations between genotypes or clinical characteristics and complications were estimated using multivariable regression models.Results. Among the 2348 eligible participants, 54.2% had an implantable, foreign body of some type. This proportion increased significantly during the 21-year study period, by 0.96% annually (P = .002), as did comorbid conditions and acquisition outside of the hospital. Rates of any metastatic complication also significantly increased, by 0.94% annually (P = .019). Among the corresponding bloodstream S. aureus isolates, spa-CC012 (multi-locus sequence type [MLST] CC30), -CC004 (MLST CC45), -CC189 (MLST CC1), and -CC084 (MLST CC15) all significantly declined during the study period, while spa-CC008 (MLST CC8) significantly increased. Patients with SAB due to spa-CC008 were significantly more likely to develop metastatic complications in general, and abscesses, septic emboli, and persistent bacteremia in particular. After adjusting for demographic, racial, and clinical variables, the USA300 variant of spa-CC008 was independently associated with metastatic complications (odds ratio 1.42; 95% confidence interval 1.02-1.99).Conclusions. Systematic approaches for monitoring complications of SAB and genotyping the corresponding bloodstream isolates will help identify the emergence of hypervirulent clones and likely improve clinical management of this syndrome.