Risk Factors Associated with Methicillin Resistance among Staphylococcus aureus Infections in Veterans
Risk Factors Associated with Methicillin Resistance among Staphylococcus aureus Infections in Veterans
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DOI：
10.1086/649017
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发表时间：
2010-01-01
影响因子：
4.5
通讯作者：
Rimland, David
中科院分区：
文献类型：
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作者：
McCarthy, Natalie L.;Sullivan, Patrick S.;Rimland, David
背景。耐甲氧西林金黄色葡萄球菌（MRSA）是一个新兴的关注在传染病实践。尽管MRSA感染发生在各种解剖部位，但大多数考虑金黄色葡萄球菌感染中甲氧西林耐药危险因素的研究都集中在MRSA菌血症上。目的：探讨不同解剖部位金黄色葡萄球菌感染耐甲氧西林的相关危险因素。我们收集了2007年6月至2008年5月期间在亚特兰大退伍军人事务医疗中心检查的金黄色葡萄球菌感染患者的人口学和临床特征信息。我们使用多元逻辑回归来描述与甲氧西林耐药显著相关的因素。528例患者中金黄色葡萄球菌感染568例。我们发现352例（62%）MRSA感染和216例（38%）甲氧西林敏感金黄色葡萄球菌感染。有MRSA感染史的患者发生甲氧西林耐药的调整后几率较高（比值比[OR]， 3.9[95%可信区间{CI}， 2.3-6.4]）或过去12个月内住在长期护理机构的患者（比值比，2.0 [95% CI, 1.0-4.0]），但在过去12个月内接受活组织检查的患者发生感染的调整后几率较低（比值比，0.7 [95% CI, 0.6-0.9]）。568例感染中以社区感染为主（523例[92%]），约一半（278例[49%]）感染与卫生保健无关。与以往对金黄色葡萄球菌菌血症患者甲氧西林耐药的研究相比，我们发现类似的因素与从更多样化的感染解剖部位恢复的金黄色葡萄球菌分离株的甲氧西林耐药有关。值得注意的是，近一半的MRSA感染病例与医疗保健无关。
BACKGROUND. Methicillin-resistant Staphylococcus aureus (MRSA) is an emerging concern in infectious disease practice. Although MRSA infections occur in a wide variety of anatomic sites, the majority of studies considering the risk factors for methicillin resistance among S. aureus infections have focused on MRSA bacteremia.OBJECTIVE. To describe risk factors associated with methicillin resistance among S. aureus infections at different anatomic sites.METHODS. We collected information on the demographic and clinical characteristics of patients examined at the Atlanta Veterans Affairs Medical Center with S. aureus infections during the period from June 2007 through May 2008. We used multivariate logistic regression to describe factors significantly associated with methicillin resistance.RESULTS. There were 568 cases of S. aureus infection among 528 patients. We identified 352 cases (62%) of MRSA infection and 216 cases (38%) of methicillin-sensitive S. aureus infection. The adjusted odds of methicillin resistance were higher among infections that occurred among patients who had a prior history of MRSA infection (odds ratio [OR], 3.9 [95% confidence interval {CI}, 2.3-6.4]) or resided in a long-term care facility during the past 12 months (OR, 2.0 [95% CI, 1.0-4.0]) but were lower for infections that occurred among patients who had undergone a biopsy procedure during the past 12 months (OR, 0.7 [95% CI, 0.6-0.9]). Most cases of infection were community-onset infections (523 [92%] of 568 cases), and about one-half (278 [49%]) were not healthcare associated.CONCLUSIONS. Compared with previous studies of methicillin resistance among patients with S. aureus bacteremia, we found similar factors to be associated with methicillin resistance among S. aureus isolates recovered from more diverse anatomic sites of infection. Of note, nearly one-half of our cases of MRSA infection were not healthcare associated.