Staphylococcal Toxic Shock Syndrome 2000-2006: Epidemiology, Clinical Features, and Molecular Characteristics
Staphylococcal Toxic Shock Syndrome 2000-2006: Epidemiology, Clinical Features, and Molecular Characteristics
复制标题
DOI：
10.1371/journal.pone.0022997
复制
发表时间：
2011-08-10
期刊：
影响因子：
3.7
通讯作者：
Lynfield, Ruth
中科院分区：
文献类型：
--
作者：
DeVries, Aaron S.;Lesher, Lindsey;Lynfield, Ruth
简介：在过去的30年中，金黄色葡萄球菌（SA）的循环菌株发生了变化，包括社区相关耐甲氧西林SA（MRSA）的出现。一份报告显示，葡萄球菌中毒性休克综合征（TSS）在2000-2003年期间呈上升趋势。最后一次基于人群的TSS评估是1986年。方法：2000-2006年，在明尼阿波利斯-圣保罗地区（人口2，642，056）使用ICD-9代码对符合CDC定义的TSS进行了基于人群的主动监测。对潜在病例的病历进行了病例标准、抗菌药物敏感性、风险因素和结局的审查。超抗原PCR检测和PFGE进行可用的分离株从可能的和确诊的cases.Results：7,491住院接受ICD-9研究代码之一，61 TSS情况下（33月经，28非月经）被确定。所有TSS、月经TSS和非月经TSS的平均年发病率分别为0.52（95% CI，0.32-0.77）、0.69（0.39-1.16）和0.32（0.12-0.67）/100，000。13-24岁妇女的发病率最高，为1.41（0.63-2.61）。从2000年至2006年，发病率没有增加。在1例月经和3例非月经病例中分离出MRSA（占TSS病例的7%）; 1株分离株为USA 400。超抗原基因tst-1在20个（80%）分离株中被鉴定出来，与非月经分离株相比，在月经中更常见（89%对50%，p = 0.07）。与月经分离株相比，超抗原基因SEA、SEB和SEC在非月经分离株中更常见[100%vs25%]（p = 0.4），60% vs 0%（p < 0.01），25% vs 13%（p = 0.5）]。在我们2000-2006年的监测期间，与过去20世纪80年代基于人群的估计相比，TSS发病率保持稳定。MRSA占TSS病例的一小部分。TST-1仍然是与大多数月经病例相关的超抗原。CDC病例定义确定了最严重的病例，并一直使用，但可能导致严重低估了TSS疾病总负担。
Introduction: Circulating strains of Staphylococcus aureus (SA) have changed in the last 30 years including the emergence of community-associated methicillin-resistant SA (MRSA). A report suggested staphylococcal toxic shock syndrome (TSS) was increasing over 2000-2003. The last population-based assessment of TSS was 1986.Methods: Population-based active surveillance for TSS meeting the CDC definition using ICD-9 codes was conducted in the Minneapolis-St. Paul area (population 2,642,056) from 2000-2006. Medical records of potential cases were reviewed for case criteria, antimicrobial susceptibility, risk factors, and outcome. Superantigen PCR testing and PFGE were performed on available isolates from probable and confirmed cases.Results: Of 7,491 hospitalizations that received one of the ICD-9 study codes, 61 TSS cases (33 menstrual, 28 non-menstrual) were identified. The average annual incidence per 100,000 of all, menstrual, and non-menstrual TSS was 0.52 (95% CI, 0.32-0.77), 0.69 (0.39-1.16), and 0.32 (0.12-0.67), respectively. Women 13-24 years had the highest incidence at 1.41 (0.63-2.61). No increase in incidence was observed from 2000-2006. MRSA was isolated in 1 menstrual and 3 non-menstrual cases (7% of TSS cases); 1 isolate was USA400. The superantigen gene tst-1 was identified in 20 (80%) of isolates and was more common in menstrual compared to non-menstrual isolates (89% vs. 50%, p = 0.07). Superantigen genes sea, seb and sec were found more frequently among non-menstrual compared to menstrual isolates [100% vs 25% (p = 0.4), 60% vs 0% (p < 0.01), and 25% vs 13% (p = 0.5), respectively].Discussion: TSS incidence remained stable across our surveillance period of 2000-2006 and compared to past population-based estimates in the 1980s. MRSA accounted for a small percentage of TSS cases. tst-1 continues to be the superantigen associated with the majority of menstrual cases. The CDC case definition identifies the most severe cases and has been consistently used but likely results in a substantial underestimation of the total TSS disease burden.