Community-acquired methicillin-resistant Staphylococcus aureus:: current perspectives
Community-acquired methicillin-resistant Staphylococcus aureus:: current perspectives
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DOI：
10.1111/j.1469-0691.2006.01341.x
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发表时间：
2006-03-01
影响因子：
14.2
通讯作者：
Kluytmans, JAJW
中科院分区：
文献类型：
--
作者：
Kluytmans-VandenBergh, MFQ;Kluytmans, JAJW
耐甲氧西林金黄色葡萄球菌 (MRSA) 已成为一个世界性问题，尽管其患病率在不同国家之间差异很大。 MRSA 的流行病学正在发生变化；感染不再局限于医院环境，也出现在没有确定感染 MRSA 风险因素的健康社区居民中。各研究报告的社区获得性 MRSA (CA-MRSA) 患病率差异很大，这主要是因为采用的定义不同以及研究进行的环境不同。目前，基于葡萄球菌盒式染色体 mec (SCCmec) 分型和 MRSA 分离株的系统发育分析的分子流行病学定义被认为是区分医院获得性 MRSA (HA-MRSA) 和 CA-MRSA 的最可靠方法。 CA-MRSA 主要从皮肤和软组织感染中分离出来，例如脓肿、蜂窝织炎、毛囊炎和脓疱病。尽管 CA-MRSA 感染通常是轻微的，但也可能很严重，并可能导致住院甚至死亡。 CA-MRSA 菌株不同于 MRSA 的主要大流行性克隆，后者占流行性 HA-MRSA 菌株的大多数。 SCCmec 类型、细菌生长速度以及抗生素抗性基因和毒素基因的分布存在差异。数学模型表明，CA-MRSA 极有可能在社区中流行，这将对医院环境中 MRSA 的控制产生重大影响。需要精心设计、基于社区的研究和充分的危险因素分析，以进一步阐明 CA-MRSA 的流行病学，并改进在社区和医院环境中控制 MRSA 的策略。
Methicillin-resistant Staphylococcus aureus (MRSA) has become a worldwide problem, although its prevalence varies considerably among countries. The epidemiology of MRSA is now changing; infections are no longer confined to the hospital setting, but also appear in healthy community-dwelling individuals without established risk factors for the acquisition of MRSA. Reported prevalence rates of community-acquired MRSA (CA-MRSA) vary widely among studies-largely because of the different definitions employed and different settings in which the studies have been performed. At present, molecular epidemiological definitions, based on staphylococcal cassette chromosome mec (SCCmec) typing and phylogenetic analyses of the MRSA isolates, are considered the most reliable means by which to distinguish between hospital-acquired MRSA (HA-MRSA) and CA-MRSA. CA-MRSA has been isolated predominantly from skin and soft tissue infections, such as abscesses, cellulitis, folliculitis and impetigo. Although CA-MRSA infections are usually mild, they may also be severe, and can result in hospitalisation and even death. CA-MRSA strains differ from the major pandemic clones of MRSA that account for the majority of epidemic HA-MRSA strains. Differences are found in SCCmec types, bacterial growth rate, and the distribution of antibiotic resistance genes and toxin genes. Mathematical models have shown that CA-MRSA has a high potential to become endemic in the community, and this will impact significantly on the control of MRSA in the hospital setting. Well-designed, community-based studies with adequate risk factor analysis are required to further elucidate the epidemiology of CA-MRSA and to improve strategies to control MRSA in both the community and hospital settings.