Colonization of HIV-infected outpatients in Taiwan with methicillin-resistant and methicillin-susceptible Staphylococcus aureus
Colonization of HIV-infected outpatients in Taiwan with methicillin-resistant and methicillin-susceptible Staphylococcus aureus
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DOI：
10.1258/095646203322025786
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发表时间：
2003-07-01
影响因子：
1.4
通讯作者：
Hung, CC
中科院分区：
文献类型：
--
作者：
McDonald, LC;Lauderdale, TL;Hung, CC
为了更好地了解在台湾具有特殊公共卫生重要性的细菌病原体的流行病学，我们确定了甲氧西林敏感的金黄色葡萄球菌（MSSA）和甲氧西林耐药的S.金黄色葡萄球菌（MRSA）在两个医院门诊部就诊的HIV感染患者队列中。1999年5月至9月期间定期随访的所有HIV感染患者均入选，并使用干海绵拭子进行前鼻孔培养。所有确认的S。根据临床实验室标准国家委员会的建议，使用纸片扩散法对金黄色葡萄球菌分离株进行抗微生物敏感性测试。在总共162名门诊患者中，发现48名（30%）被S.金黄色葡萄球菌，包括39（24%）与MSSA和9（6%）与MRSA定植。与MSSA定植相关的唯一因素是接受甲氧苄啶-磺胺甲恶唑治疗，这似乎具有保护作用（相对风险0.4，95%置信区间[CI 95] 0.2-0.78，P=0.006）。相比之下，环丙沙星的使用是MRSA定植的独立风险因素（条件优势比[OR] 11-9，CI 95 1.8-77.8，P=0.010），沿着CD 4计数降低四分之一（OR 3.9，CI 95 1.1-14.3，P=0.04）。虽然MRSA定植与前三个月内的住院治疗无关，但MRSA分离株的多重耐药模式表明菌株在医疗环境中的某个时间点获得。在台湾HIV感染门诊病人中，金黄色葡萄球菌定植率为30%。低CD 4+计数最有可能与MRSA的其他未测量的风险因素相关。抗菌药物的使用可能作为一个保护性或风险因素与S定植。金黄色葡萄球菌，这取决于所涉及的药物和遇到的耐药性。氟喹诺酮类药物的使用可能在MRSA从住院患者向门诊患者传播中起重要作用。
To better understand the epidemiology of bacterial pathogens with particular public health importance in Taiwan, we determined the prevalence of nasal colonization with methicillin-susceptible Staphylococcus aureus (MSSA) and methicillin-resistant S. aureus (MRSA) in a cohort of HIV-infected patients attending two hospital outpatient departments. All HIV-infected patients followed regularly between May and September 1999 were enrolled and cultures of the anterior nares were performed using a dry sponge swab. All confirmed S. aureus isolates underwent antimicrobial susceptibility testing using disk diffusion according to recommendations of the National Committee for Clinical Laboratory Standards. Of a total of 162 outpatients studied, 48 (30%) were found colonized with S. aureus including 39 (24%) colonized with MSSA and 9 (6%) colonized with MRSA. The only factor associated with MSSA colonization was receipt of trimethoprim-sulphamethoxazole which appeared protective (relative risk 0.4, 95% confidence interval [CI95] 0.2-0.78, P=0.006). In contrast, ciprofloxacin use was an independent risk factor for MRSA colonization (conditional odds ratio [OR] 11-9, CI95 1.8-77.8, P=0.010) along with a one-quartile reduction in CD4 count (OR 3.9, CI95 1.1-14.3, P=0.04). Although MRSA colonization was not associated with hospitalization within the previous three months, the multi-drug resistance pattern of MRSA isolates suggests strains were at some point acquired in the healthcare setting.Our study shows that the rate of S. aureus colonization in Taiwanese HIV-infected outpatients is 30%. Low CD4+ counts are most likely associated with other unmeasured risk factors for MRSA. Antimicrobial use may function alternatively as a protective or risk factor for colonization with S. aureus, depending upon the drugs involved and resistance encountered. Fluoroquinolone use may have an important role in the spread of MRSA from inpatient to outpatient settings.