Burden of Invasive Staphylococcus aureus Infections in Hospitalized Infants
Burden of Invasive Staphylococcus aureus Infections in Hospitalized Infants
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DOI：
10.1001/jamapediatrics.2015.2380
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发表时间：
2015-12-01
期刊：
影响因子：
26.1
通讯作者：
Milstone, Aaron M.
中科院分区：
文献类型：
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作者：
Ericson, Jessica E.;Popoola, Victor O.;Milstone, Aaron M.
重要性：金黄色葡萄球菌是住院婴儿感染的常见原因。这些感染与死亡率和发病率增加以及住院时间延长有关，但关于住院婴儿金黄色葡萄球菌疾病负担的数据有限。目的比较侵袭性耐甲氧西林金黄色葡萄球菌（MRSA）和甲氧西林敏感金黄色葡萄球菌（MSSA）患儿的人口统计学特征和死亡率，确定每年MRSA金黄色葡萄球菌感染的比例，并对比侵袭性MRSA感染和侵袭性MSSA感染后的死亡风险。设计、环境和参与者：对由儿科医疗集团管理的348个新生儿重症监护病房的大型、具有全国代表性的队列进行多中心回顾性研究。研究对象是3888名患有侵袭性金黄色葡萄球菌感染的婴儿，他们于1997年至2012年出院。侵袭性金黄色葡萄球菌感染。侵袭性金黄色葡萄球菌感染的发生率，以及MRSA或MSSA感染后的婴儿特征和死亡率。结果3888例患儿发生侵袭性金黄色葡萄球菌感染3978例（其中MSSA 2868例，MRSA 1110例）。侵袭性金黄色葡萄球菌感染的发生率为44.8 / 1万名婴儿。从1997年历年到2006年历年，MRSA引起的侵袭性感染的年度比例有所增加，此后略有下降。侵袭性MRSA或MSSA感染的婴儿有相似的胎龄和出生体重。侵袭性耐甲氧西林金黄色葡萄球菌感染更常发生在较年轻的产后年龄。在有可用死亡率数据的婴儿中，侵袭性MSSA感染的婴儿（n = 237）在出院前死亡的人数多于侵袭性MRSA感染的婴儿（n = 110）。侵入性MSSA和MRSA感染后死亡的婴儿比例相似，分别为2474例中的237例（9.6%）和926例中的110例（11.9%）（P = 0.05）。侵袭性MSSA和MRSA感染后出院前校正死亡风险相似（风险比为1.19；95% CI为0.96-1.49）。侵袭性MSSA感染的婴儿和侵袭性MRSA感染的婴儿在侵袭性感染后7天和30天的死亡风险相似。结论和相关性：侵袭性MRSA和MSSA感染后的婴儿死亡率相似，但MSSA引起的婴儿感染和死亡比MRSA更多。预防金黄色葡萄球菌感染的措施除MRSA外还应包括MSSA。
IMPORTANCE Staphylococcus aureus is a frequent cause of infection in hospitalized infants. These infections are associated with increased mortality and morbidity and longer hospital stays, but data on the burden of S aureus disease in hospitalized infants are limited.OBJECTIVES To compare demographics and mortality of infants with invasive methicillin-resistant S aureus (MRSA) and methicillin-susceptible S aureus (MSSA), to determine the annual proportion of S aureus infections that were MRSA, and to contrast the risk of death after an invasive MRSA infection with the risk after an invasive MSSA infection.DESIGN, SETTING, AND PARTICIPANTS Multicenter retrospective study of a large, nationally representative cohort at 348 neonatal intensive care units managed by the Pediatrix Medical Group. Participants were 3888 infants with an invasive S aureus infection who were discharged from calendar year 1997 through calendar year 2012.EXPOSURE Invasive S aureus infection.MAIN OUTCOMES AND MEASURES The incidence of invasive S aureus infections, as well as infant characteristics and mortality after MRSA or MSSA infection.RESULTS The 3888 infants had 3978 invasive S aureus infections (2868 MSSA and 1110 MRSA). The incidence of invasive S aureus infection was 44.8 infections per 10 000 infants. The yearly proportion of invasive infections caused by MRSA increased from calendar year 1997 through calendar year 2006 and has moderately decreased since then. Infants with invasive MRSA or MSSA infections had similar gestational ages and birth weights. Invasive MRSA infections occurred more often at a younger postnatal age. For infants with available mortality data, more infants with invasive MSSA infections (n = 237) died before hospital discharge than infants with invasive MRSA infections (n = 110). The proportions of infants who died after invasive MSSA and MRSA infections were similar at 237 of 2474 (9.6%) and 110 of 926 (11.9%), respectively (P = .05). The adjusted risk of death before hospital discharge was similar after invasive MSSA and MRSA infections (risk ratio, 1.19; 95% CI, 0.96-1.49). The risks of death at 7 and 30 days after invasive infection were similar between infants with invasive MSSA infection and infants with invasive MRSA infection.CONCLUSIONS AND RELEVANCE Infant mortality after invasive MRSA and MSSA infections is similar, but MSSA causes more infections and more deaths in infants than MRSA. Measures to prevent S aureus infection should include MSSA in addition to MRSA.