Methicillin-resistant S-aureus infections among patients in the emergency department
Methicillin-resistant S-aureus infections among patients in the emergency department
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DOI：
10.1056/nejmoa055356
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发表时间：
2006-08-17
影响因子：
158.5
通讯作者：
Talan, David A.
中科院分区：
文献类型：
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作者：
Moran, Gregory J.;Krishnadasan, Anusha;Talan, David A.
背景：耐甲氧西林金黄色葡萄球菌（MRSA）是越来越多地认识到在社区的人之间的感染，没有建立的危险因素，为MRSA.METHODS：我们招募了成人急性化脓性皮肤和软组织感染的11个大学附属急诊科在2004年8月。获得培养物，并收集临床信息。可用S.通过抗菌药物敏感性试验、脉冲场凝胶电泳和毒素基因检测来表征金黄色葡萄球菌分离株。在MRSA分离株中，我们对葡萄球菌盒式染色体mec（SCCmec）进行了分型，SCCmec是携带编码甲氧西林耐药的mecA基因的遗传元件。金黄色葡萄球菌：从422名皮肤和软组织感染患者中的320名（76%）中分离出来。MRSA的患病率为59%，范围从15%到74%。脉冲场型USA 300分离株占MRSA分离株的97%;其中74%是单一菌株（USA 300 -0114）。在98%的MRSA分离株中检测到SCCmec IV型和Panton-Valentine杀白细胞素毒素基因。其他毒素基因很少检测到。在MRSA分离株中，95%对克林霉素敏感，6%对红霉素敏感，60%对氟喹诺酮类敏感，100%对利福平和甲氧苄啶-磺胺甲恶唑敏感，92%对四环素敏感。在175例接受抗生素治疗的MRSA感染患者中，有100例（57%）的抗生素治疗与药敏试验结果不一致。在对甲氧西林敏感的S.金黄色葡萄球菌分离株中，31%是USA 300，42%含有pvl基因。结论：MRSA是美国11个城市急诊科患者皮肤和软组织感染的最常见可识别原因。当抗菌治疗适用于治疗皮肤和软组织感染时，临床医生应考虑获得培养物并修改经验性治疗以提供MRSA覆盖范围。
BACKGROUND:Methicillin-resistant Staphylococcus aureus (MRSA) is increasingly recognized in infections among persons in the community without established risk factors for MRSA.METHODS:We enrolled adult patients with acute, purulent skin and soft-tissue infections presenting to 11 university-affiliated emergency departments during the month of August 2004. Cultures were obtained, and clinical information was collected. Available S. aureus isolates were characterized by antimicrobial-susceptibility testing, pulsed-field gel electrophoresis, and detection of toxin genes. On MRSA isolates, we performed typing of the staphylococcal cassette chromosome mec (SCCmec), the genetic element that carries the mecA gene encoding methicillin resistance.RESULTSS. aureus: was isolated from 320 of 422 patients with skin and soft-tissue infections (76 percent). The prevalence of MRSA was 59 percent overall and ranged from 15 to 74 percent. Pulsed-field type USA300 isolates accounted for 97 percent of MRSA isolates; 74 percent of these were a single strain (USA300-0114). SCCmec type IV and the Panton-Valentine leukocidin toxin gene were detected in 98 percent of MRSA isolates. Other toxin genes were detected rarely. Among the MRSA isolates, 95 percent were susceptible to clindamycin, 6 percent to erythromycin, 60 percent to fluoroquinolones, 100 percent to rifampin and trimethoprim-sulfamethoxazole, and 92 percent to tetracycline. Antibiotic therapy was not concordant with the results of susceptibility testing in 100 of 175 patients with MRSA infection who received antibiotics (57 percent). Among methicillin-susceptible S. aureus isolates, 31 percent were USA300 and 42 percent contained pvl genes.CONCLUSIONS:MRSA is the most common identifiable cause of skin and soft-tissue infections among patients presenting to emergency departments in 11 U.S. cities. When antimicrobial therapy is indicated for the treatment of skin and soft-tissue infections, clinicians should consider obtaining cultures and modifying empirical therapy to provide MRSA coverage.