Impact of Traditional Hospital Strain of Methicillin-Resistant Staphylococcus aureus (MRSA) and Community Strain of MRSA on Mortality in Patients With Community-Onset S aureus Bacteremia
Impact of Traditional Hospital Strain of Methicillin-Resistant Staphylococcus aureus (MRSA) and Community Strain of MRSA on Mortality in Patients With Community-Onset S aureus Bacteremia
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DOI：
10.1097/md.0b013e3181f1851e
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发表时间：
2010-09-01
期刊：
影响因子：
1.6
通讯作者：
Chang, Shan-Chwen
中科院分区：
文献类型：
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作者：
Chen, Shey-Ying;Wang, Jann-Tay;Chang, Shan-Chwen
社区相关耐甲氧西林金黄色葡萄球菌（MRSA）已成为社区和医院感染的重要病原菌。这些新出现的MRSA菌株对社区发病的金黄色葡萄球菌菌血症成人患者死亡率的影响仍不确定。根据SCCmec分子分型结果，我们将社区株MRSA（CoSt-MRSA）和医院株MRSA（HoSt-MRSA）分为两类：CoSt-MRSA具有SCCmec IV或V型基因，HoSt-MRSA具有SCCmec I、II或III型基因。通过与甲氧西林敏感金黄色葡萄球菌（MSSA）菌血症患者的死亡率进行比较，我们定量评估了MRSA菌株对CoSt-MRSA或Host-MRSA菌血症患者死亡率的影响。我们研究了2001年1月1日至12月31日期间500例MSSA菌血症患者、111例CoSt-MRSA患者和133例Host-MRSA菌血症患者的观察性队列。2007. MSSA、Cost-MRSA和Host-MRSA菌血症患者的90天累积生存概率分别为71%、70%和55（p = 0.014，通过Wilcoxon秩和检验）。与MSSA菌血症患者相比，在校正所有潜在混杂因素后的第一个多变量分析模型中，（风险比[HR]，1.525; 95%置信区间[CI]，1.091-2.131），在第二个模型中调整了除菌血症急性严重程度外的所有混杂因素（HR，1.489; 95% CI，1.071-2.070），在Charlson合并症评分较低的患者中进行分层分析（0-2分）（HR，3.093; 95%CI，1.507-6.350），在2个多变量分析模型中，与MSSA菌血症患者相比，Cost-MRSA菌血症患者的死亡率无显著差异（第一个模型：HR，1.106; 95% CI，0.748-1.637;第二个模型：HR，1.028; 95% CI，0.697-1.516）或分层分析（HR，1.092; 95%CI，0.539-2.214）。总之，以MSSA为参考，传统医院菌株MRSA对菌血症死亡率的影响高于社区菌株MRSA。
Community-associated methicillin-resistant Staphylococcus aureus (MRSA) has become an important pathogen in community and nosocomial infections. The impact of these emerging MRSA strains on mortality in adult patients with community-onset S aureus bacteremia remains uncertain. We defined community strain MRSA (CoSt-MRSA) and hospital strain MRSA (HoSt-MRSA) according to the results of staphylococcus cassette chromosome mec (SCCmec) molecular typing: CoSt-MRSA isolates had SCCmec type IV or V genes, and HoSt-MRSA isolates had SCCmec type I, II, or III genes. We quantitatively evaluated the impact of the MRSA strain on mortality in patients with CoSt-MRSA or HoSt-MRSA bacteremia by comparison with mortality in patients with methicillin-susceptible S aureus (MSSA) bacteremia.We studied an observational cohort of 500 patients with MSSA bacteremia, 111 patients with CoSt-MRSA, and 133 patients with HoSt-MRSA bacteremia from January 1, 2001, through December 31, 2007. The 90-day cumulative probability of survival in patients with MSSA, CoSt-MRSA, and HoSt-MRSA bacteremia was 71%, 70%, and 55%, respectively (p = 0.014, by Wilcoxon rank-sum test).Compared to patients with MSSA bacteremia, patients with HoSt-MRSA bacteremia were associated with an increased risk of mortality in the first multivariate analysis model adjusting for all potential confounders (hazard ratio [HR], 1.525; 95% confidence interval [CI], 1.091-2.131), in the second model adjusting for all confounders except acute severity of bacteremia (HR, 1.489; 95% CI, 1.071-2.070), and in stratified analysis in patients with low Charlson comorbidity scores (score 0-2) (HR, 3.093; 95% CI, 1.507-6.350).Compared to patients with MSSA bacteremia, patients with CoSt-MRSA bacteremia did not show significant differences in mortality rate in the 2 multivariate analysis models (first model: HR, 1.106; 95% CI, 0.748-1.637; second model: HR, 1.028; 95% CI, 0.697-1.516) or in stratified analysis (HR, 1.092; 95% CI, 0.539-2.214).In conclusion, using MSSA as reference, traditional hospital strain MRSA had a higher impact on bacteremia mortality than community strain MRSA.