Methicillin-susceptible Staphylococcus aureus as a predominantly healthcare-associated pathogen: a possible reversal of roles?
Methicillin-susceptible Staphylococcus aureus as a predominantly healthcare-associated pathogen: a possible reversal of roles?
复制标题
DOI：
10.1371/journal.pone.0018217
复制
发表时间：
2011-04-13
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;Boyle-Vavra S;Zychowski DL;Daum RS
耐甲氧西林金黄色葡萄球菌(MRSA)菌株已成为原本健康的人中皮肤和软组织感染(SSTI)的常见原因，在20世纪90年代中期之前，这是甲氧西林敏感(MSSA)菌株的作用。我们推测，随着MRSA感染在社区金黄色葡萄球菌感染中变得越来越常见，也许MSSA感染作为与医疗保健相关的感染的原因变得更加重要。我们比较了2004年7月1日至2005年6月30日在芝加哥大学医学中心(UCMC)所有临床单位感染MRSA和MSSA的患者，包括儿童和成人；我们还比较了感染细菌株的MRSA和MSSA的基因类型。与耐甲氧西林金黄色葡萄球菌患者相比，在双变量分析中，甲氧西林金黄色葡萄球菌患者更有可能在培养时有菌血症、心内膜炎或败血症(p = 0.005)、成人(p = 0.03)、重症监护病房(21.9%比15.6%)或其他病房(45.6%比40.7%)。MRSA(346/545)和MSSA(76/114)患者的HA-S比例无显著差异。按疾控中心CA-MRSA定义的金黄色葡萄球菌(p = 0.5)。MRSA和MSSA多位点序列类型(ST)1、ST5、ST8、ST30和ST59的遗传背景分别占MRSA分离株和MSSA分离株的94.5%和50.9%。Logistic回归分析显示，在急诊科就诊(OR4.6，CI1.5~14.0，p = 0.008)与耐甲氧西林金黄色葡萄球菌感染有关。UCMC的MSSA患者比MRSA患者更容易出现与医疗保健相关的感染特征；MSSA和MRSA菌株可能发生了角色颠倒。临床分离的MSSA和MRSA具有相同的基因背景。
Methicillin-resistant Staphylococcus aureus (MRSA) strains have become common causes of skin and soft tissue infections (SSTI) among previously healthy people, a role of methicillin-susceptible (MSSA) isolates before the mid-1990s. We hypothesized that, as MRSA infections became more common among S. aureus infections in the community, perhaps MSSA infections had become more important as a cause of healthcare-associated infection. We compared patients, including children and adults, with MRSA and MSSA infections at the University of Chicago Medical Center (UCMC) from all clinical units from July 1, 2004-June 30, 2005; we also compared the genotypes of the MRSA and MSSA infecting bacterial strains. Compared with MRSA patients, MSSA patients were more likely on bivariate analysis to have bacteremia, endocarditis, or sepsis (p = 0.03), to be an adult (p = 0.005), to be in the intensive care unit (21.9% vs. 15.6%) or another inpatient unit (45.6% vs. 40.7%) at the time of culture. MRSA (346/545) and MSSA (76/114) patients did not differ significantly in the proportion classified as HA-S. aureus by the CDC CA-MRSA definition (p = 0.5). The genetic backgrounds of MRSA and MSSA multilocus sequence type (ST) 1, ST5, ST8, ST30, and ST59 comprised in combination 94.5% of MRSA isolates and 50.9% of MSSA isolates. By logistic regression, being cared for in the Emergency Department (OR 4.6, CI 1.5-14.0, p = 0.008) was associated with MRSA infection. Patients with MSSA at UCMC have characteristics consistent with a health-care-associated infection more often than do patients with MRSA; a possible role reversal has occurred for MSSA and MRSA strains. Clinical MSSA and MRSA strains shared genotype backgrounds.
登录
查看更多内容
影响因子：
14.2
作者：
Donker, G. A.;Deurenberg, R. H.;Stobberingh, E. E.
通讯作者：
Stobberingh, E. E.
影响因子：
4.5
作者：
McCarthy, Natalie L.;Sullivan, Patrick S.;Rimland, David
通讯作者：
Rimland, David
影响因子：
120.7
作者：
Klevens, R. Monina;Morrison, Melissa A.;Fridkin, Scott K.
通讯作者：
Fridkin, Scott K.
影响因子：
15.9
作者：
Melles, DC;Gorkink, RFJ;van Belkum, A
通讯作者：
van Belkum, A
影响因子：
6.4
作者：
Cespedes, C;Sa誰d-Salim, B;Lowy, FD
通讯作者：
Lowy, FD